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General NPI Number Information
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NPI Number | 1548785835
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Entity Type | Individual
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Provider Name | MRS. MANG MOUA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 7005 N MAPLE AVE STE 104
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City | FRESNO
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State | CA
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Zip | 93720-8009
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Country | US
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Telephone | 559-325-3503
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 N PEACH AVE APT 110
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City | FRESNO
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State | CA
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Zip | 93727-2078
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Country | US
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Telephone | 559-519-8025
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA3789
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License Number State | CA
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