Healthcare Provider Details

I. General information

NPI: 1609155092
Provider Name (Legal Business Name): MAI LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 BIG HORN BLVD STE 6
ELK GROVE CA
95758-1101
US

IV. Provider business mailing address

9412 BIG HORN BLVD STE 6
ELK GROVE CA
95758-1101
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5122
  • Fax: 916-609-5161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: