Healthcare Provider Details

I. General information

NPI: 1235673542
Provider Name (Legal Business Name): XIA VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S MADERA AVE
MADERA CA
93637-5576
US

IV. Provider business mailing address

1105 S MADERA AVE
MADERA CA
93637-5576
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-6133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: