MEDICARE: MARY CHAU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A7618	CA

General Provider Information

NPI Number	:	1255365888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHAU D.O.

Provider Business Mailing Address
First Line	:	28125 BRADLEY RD
Second Line	:	SUITE 240B
City	:	SUN CITY
State	:	CA
Zip	:	92586-2248
Country	:	US
Telephone Number	:	951-301-6366
Fax Number	:	951-301-6366

Provider Business Practice Location Address
First Line	:	28125 BRADLEY RD
Second Line	:	SUITE 240B
City	:	SUN CITY
State	:	CA
Zip	:	92586-2248
Country	:	US
Telephone Number	:	951-301-6366
Fax Number	:	951-301-6366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/09/2007

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Directions to “ MARY CHAU D.O.” Practice Location

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