Healthcare Provider Details

I. General information

NPI: 1528610870
Provider Name (Legal Business Name): JOSEPHINE HOA NGOC MAI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOA NGOC MAI

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax: 619-659-3140
Mailing address:
  • Phone: 619-445-1188
  • Fax: 619-659-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA58572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: