Healthcare Provider Details

I. General information

NPI: 1063670966
Provider Name (Legal Business Name): LOAN DAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 2ND AVE
ESCONDIDO CA
92025-4249
US

IV. Provider business mailing address

225 E 2ND AVE
ESCONDIDO CA
92025-4249
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6700
  • Fax: 760-737-7324
Mailing address:
  • Phone: 760-291-6700
  • Fax: 760-737-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: