Provider Demographics
NPI:1376210260
Name:MOUA, PORSCHA XIALIA (MS)
Entity Type:Individual
Prefix:
First Name:PORSCHA
Middle Name:XIALIA
Last Name:MOUA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:PORSCHA
Other - Middle Name:XIALIA
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4249 W. BULLARD AVENUE APT. 230
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722
Mailing Address - Country:US
Mailing Address - Phone:916-417-5994
Mailing Address - Fax:
Practice Address - Street 1:2505 W SHAW AVE BLDG A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3334
Practice Address - Country:US
Practice Address - Phone:559-228-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist