MEDICARE: MAI SA LAO PMHNP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	95216204	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95036846	CA

General Provider Information

NPI Number	:	1386234680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI SA LAO PMHNP

Provider Business Mailing Address
First Line	:	7766 N PALM AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-5708
Country	:	US
Telephone Number	:	559-425-0800
Fax Number	:	559-435-7720

Provider Business Practice Location Address
First Line	:	7766 N PALM AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-5708
Country	:	US
Telephone Number	:	559-435-0800
Fax Number	:

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

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	05/27/2026

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Directions to “ MAI SA LAO PMHNP” Practice Location

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