Provider Demographics
NPI:1881707222
Name:CAO, DIANA T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:T
Last Name:CAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TRANGDAI
Other - Middle Name:T
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:11201 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-1000
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3208
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521181835P0018X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Not Answered183500000XPharmacy Service ProvidersPharmacist