Provider Demographics
NPI:1538459284
Name:LA, CHRISTINE THAO (MD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:THAO
Last Name:LA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:THANH
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14441 VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3115
Mailing Address - Country:US
Mailing Address - Phone:585-267-0820
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-355-8260
Practice Address - Fax:305-355-7266
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program