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General NPI Number Information
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NPI Number | 1386959062
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Entity Type | Individual
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Provider Name | JIA MAO MD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 540 E FOOTHILL BLVD STE 100H
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City | SAN DIMAS
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State | CA
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Zip | 91773-1251
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Country | US
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Telephone | 626-466-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 FOOTHILL BLVD STE B271
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City | LA VERNE
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State | CA
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Zip | 91750-2901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A117957
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License Number State | CA
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