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Individual

LOC BAO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
500 W HOSPITAL RD, FRENCH CAMP, CA 95231-9693
(209) 468-6000
Mailing address
3037 VINTAGE WAY, MOODY, AL 35004-3057
(205) 396-9132

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-133132
AL
163W00000X
Registered Nurse
837202
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000659
CA

Other

Enumeration date
12/13/2016
Last updated
01/27/2022
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