Provider Demographics
NPI:1528474103
Name:CAO, IVY (MD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:
Last Name:CAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5202
Mailing Address - Country:US
Mailing Address - Phone:951-384-6200
Mailing Address - Fax:951-213-3449
Practice Address - Street 1:1971 UNIVERSITY AVE
Practice Address - Street 2:FAMILY MEDICINE DEPARTMENT
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-384-6200
Practice Address - Fax:858-634-6959
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty