Healthcare Provider Details

I. General information

NPI: 1285971572
Provider Name (Legal Business Name): PANGDAO THAO MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 E KINGS CANYON ROAD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4879 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-390-0963
  • Fax:
Mailing address:
  • Phone: 559-255-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: