=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043503295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC MAO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2011
-----------------------------------------------------
Last Update Date | 01/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3160 FOLSOM BLVD STE 3500
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95816-5270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-8616
-----------------------------------------------------
Fax | 916-451-2024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3160 FOLSOM BLVD STE 3500
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95816-5270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-8616
-----------------------------------------------------
Fax | 916-451-2024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | A147641
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD14655
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------