Provider Demographics
NPI:1821523366
Name:LA, TRIET MINH (DO)
Entity Type:Individual
Prefix:DR
First Name:TRIET
Middle Name:MINH
Last Name:LA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 PERSHING AVE
Mailing Address - Street 2:APT 247
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-2608
Mailing Address - Country:US
Mailing Address - Phone:281-818-3822
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST FL 10
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-702-4151
Practice Address - Fax:817-702-4161
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR92382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program