Healthcare Provider Details

I. General information

NPI: 1851793624
Provider Name (Legal Business Name): ROBERT MAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N. EL CIELO STE. C322
PALM SPRINGS CA
92262
US

IV. Provider business mailing address

255 N. EL CIELO STE. C322
PALM SPRINGS CA
92262
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-6560
  • Fax:
Mailing address:
  • Phone: 760-969-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: