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NPI Code Detail

MEDICARE: MRS. DONNA LEE MAU P.A.-C

MEDICARE: MRS. DONNA LEE MAU P.A.-C
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
1363AM0700XMedical Physician AssistantPA 15145CA
2363A00000XPhysician AssistantPA15145CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA15145OTHERCALISCENCE PHYSICIAN ASSIST

General Provider Information

NPI Number : 1669457552
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA LEE MAU P.A.-C
Provider Business Mailing Address
First Line : 2625 E DIVISADERO ST
Second Line :
City : FRESNO
State : CA
Zip : 93721-1431
Country : US
Telephone Number : 559-443-2682
Fax Number : 559-443-2681
Provider Business Practice Location Address
First Line : 290 N WAYTE LN
Second Line :
City : FRESNO
State : CA
Zip : 93701-2124
Country : US
Telephone Number : 559-459-1550
Fax Number : 559-459-1017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 06/18/2014

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