Individual
MAI SA LAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
7766 N PALM AVE STE 107, FRESNO, CA 93711-5708
(559) 435-0800
Mailing address
4411 E CESAR CHAVEZ BLVD, FRESNO, CA 93702-3604
(559) 453-1008
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
95216204
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95036846
CA
Other
Enumeration date
01/20/2021
Last updated
04/22/2026
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