Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A147641 | CA |
N | 207RG0100X | Gastroenterologist | MD14655 | RI |
NPI | 1043503295 |
---|---|
Provider Name | Eric Mao |
First Address | Sacramento, CA 95816-5270 |
Second Address | Sacramento, CA 95816-5270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2011 |
Last Update Date | 31/01/2022 |