Healthcare Provider Details

I. General information

NPI: 1528785524
Provider Name (Legal Business Name): DINNA LEA OD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 N SANTA CRUZ AVE
LOS GATOS CA
95030-5916
US

IV. Provider business mailing address

53 N SANTA CRUZ AVE
LOS GATOS CA
95030-5916
US

V. Phone/Fax

Practice location:
  • Phone: 408-399-8003
  • Fax:
Mailing address:
  • Phone: 408-399-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DINNA D LEA
Title or Position: PRESIDENT
Credential: OD
Phone: 301-346-9803