Provider Demographics
NPI:1063670966
Name:DAO, LOAN (MD)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:
Last Name:DAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CRAVEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4237
Mailing Address - Country:US
Mailing Address - Phone:760-291-6650
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:225 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4212
Practice Address - Country:US
Practice Address - Phone:866-228-2236
Practice Address - Fax:760-737-7367
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV610Medicaid
CAP00746369OtherMEDICARE RR
CAAY575SMedicare PIN