Healthcare Provider Details

I. General information

NPI: 1770192536
Provider Name (Legal Business Name): QUY ALAN DUY DAO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST STE 2100
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST STE 2100
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2600
  • Fax:
Mailing address:
  • Phone: 909-558-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: