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General NPI Number Information
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NPI Number | 1972111292
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Entity Type | Individual
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Provider Name | SHANNON MAI THAO HO PA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 420 W ROWLAND ST
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City | COVINA
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State | CA
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Zip | 91723-2943
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Country | US
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Telephone | 626-331-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 420 W ROWLAND ST
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City | COVINA
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State | CA
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Zip | 91723-2933
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Country | US
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Telephone | 626-331-6411
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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