Healthcare Provider Details

I. General information

NPI: 1104588367
Provider Name (Legal Business Name): MAI LEE LOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 SKYWOODS WAY
SACRAMENTO CA
95828-4879
US

IV. Provider business mailing address

7915 SKYWOODS WAY
SACRAMENTO CA
95828-4879
US

V. Phone/Fax

Practice location:
  • Phone: 916-708-7572
  • Fax:
Mailing address:
  • Phone: 916-708-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number154691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: