Individual
LIDA BAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
11301 WILSHIRE BLVD, BUILDING 500, LOS ANGELES, CA 90073-1003
(310) 478-3711
Mailing address
1521 S 8TH ST, ALHAMBRA, CA 91803-3241
(310) 478-3711
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
13681
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13681
NP FURNISHING NUMBER
CA
01
—
559675
REGISTERED NURSE LICENSE
CA
Enumeration date
12/15/2006
Last updated
08/20/2007
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