Healthcare Provider Details

I. General information

NPI: 1811558158
Provider Name (Legal Business Name): ALEJANDRA THI DAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 DAWES DR
DALLAS TX
75211-5760
US

IV. Provider business mailing address

3247 DAWES DR
DALLAS TX
75211-5760
US

V. Phone/Fax

Practice location:
  • Phone: 214-330-7767
  • Fax:
Mailing address:
  • Phone: 214-330-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: