Healthcare Provider Details

I. General information

NPI: 1134200165
Provider Name (Legal Business Name): DR. NINA H DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA H HA O.D.

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31401 RANCHO VIEJO RD SUITE 103
SAN JUAN CAPISTRANO CA
92675-1851
US

IV. Provider business mailing address

22 ARRIVO DR
MISSION VIEJO CA
92692-5118
US

V. Phone/Fax

Practice location:
  • Phone: 949-248-2590
  • Fax: 949-443-3828
Mailing address:
  • Phone: 714-614-0317
  • Fax: 949-443-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11797T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: