Provider Demographics
NPI:1013267574
Name:MOUNSITHIRATH, ROBO
Entity Type:Individual
Prefix:MS
First Name:ROBO
Middle Name:
Last Name:MOUNSITHIRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 11867
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93775-1915
Practice Address - Country:US
Practice Address - Phone:555-600-3229
Practice Address - Fax:559-445-2772
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse