Most Relevant Information
Provider Data
| NPI Number: | 1003636333 |
| Provider Name: | MAI CHONG THAO |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/11/2024 |
| Last Updated: | 10/11/2024 |
Provider Practice Location
5501 ANTIQUE ROSE WAY
RIVERBANK
CA
953679505
Practice Location Phone/Fax
| Phone: | 8665234268 |
| Fax: |
Provider Mailing Location
850 TOWBIN AVE
LAKEWOOD
NJ
087015928
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |