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Individual

MRS. MANG MOUA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7005 N MAPLE AVE STE 104, FRESNO, CA 93720-8009
(559) 325-3503
Mailing address
1481 N PEACH AVE APT 110, FRESNO, CA 93727-2078
(559) 519-8025

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA3789
CA

Other

Enumeration date
08/07/2017
Last updated
08/07/2017
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