Healthcare Provider Details

I. General information

NPI: 1396186219
Provider Name (Legal Business Name): THU DAO B.A., SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 BEACH BLVD SUITE 120
HUNTINGTON BEACH CA
92648-2030
US

IV. Provider business mailing address

18700 BEACH BLVD SUITE 120
HUNTINGTON BEACH CA
92648-2030
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-6760
  • Fax: 714-962-5961
Mailing address:
  • Phone: 714-962-6760
  • Fax: 714-962-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA 2105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: