Provider Demographics
NPI:1669681219
Name:MAI-WOODS-ANSTAETT, BEHANG (PA)
Entity Type:Individual
Prefix:MRS
First Name:BEHANG
Middle Name:
Last Name:MAI-WOODS-ANSTAETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8698 ELK GROVE BLVD BLDG 1-182
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3300
Mailing Address - Country:US
Mailing Address - Phone:916-216-2311
Mailing Address - Fax:
Practice Address - Street 1:923 V ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1331
Practice Address - Country:US
Practice Address - Phone:916-448-6553
Practice Address - Fax:916-448-5647
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17579OtherPHYSICAN ASSISTANT