Individual
FRED MAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
7405 N CEDAR AVE, 103, FRESNO, CA 93720-3838
(559) 261-4100
(559) 261-4101
Mailing address
7405 N CEDAR AVE, 103, FRESNO, CA 93720-3838
(559) 261-4100
(559) 261-4101
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT6214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA6172
MEDICARE RAILROAD GROUP #
CA
01
—
OT0062140
BLUE SHIELD OF CA. PIN
CA
01
—
P00089881
MEDICARE RAILROAD INDIVIDUAL ID #
CA
Enumeration date
10/04/2006
Last updated
05/27/2008
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