Healthcare Provider Details

I. General information

NPI: 1841673563
Provider Name (Legal Business Name): VAN LE DAO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15609 RONALD W REAGAN BLVD BLDG B110
LEANDER TX
78641-1476
US

IV. Provider business mailing address

15609 RONALD REAGAN BLVD STE B110
LEANDER TX
78641-7296
US

V. Phone/Fax

Practice location:
  • Phone: 512-738-8896
  • Fax: 512-793-9588
Mailing address:
  • Phone: 512-738-8896
  • Fax: 512-793-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: