Healthcare Provider Details

I. General information

NPI: 1669259982
Provider Name (Legal Business Name): MARYANN VU CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N
ALLEN TX
75013-6103
US

IV. Provider business mailing address

15305 DALLAS PKWY STE 900
ADDISON TX
75001-6482
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-1000
  • Fax:
Mailing address:
  • Phone: 469-863-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: