MEDICARE: MRS. BEHANG MAI-WOODS-ANSTAETT P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA17579	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA17579	OTHER	CA	PHYSICAN ASSISTANT

General Provider Information

NPI Number	:	1669681219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEHANG MAI-WOODS-ANSTAETT P.A.

Provider Business Mailing Address
First Line	:	8698 ELK GROVE BLVD BLDG 1-182
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-3300
Country	:	US
Telephone Number	:	916-216-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	923 V ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-1331
Country	:	US
Telephone Number	:	916-448-6553
Fax Number	:	916-448-5647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/15/2014

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