Healthcare Provider Details

I. General information

NPI: 1326541301
Provider Name (Legal Business Name): PANG LEE MOUA BA, BS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W SWIFT AVE STE 104
FRESNO CA
93722-6388
US

IV. Provider business mailing address

9755 LINCOLN VILLAGE DR
SACRAMENTO CA
95827-3334
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-7900
  • Fax:
Mailing address:
  • Phone: 916-363-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: