Basic Information
| Provider Information | |||||||||
| NPI: | 1760632087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAC | ||||||||
| FirstName: | MYLINH | ||||||||
| MiddleName: | THI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9250 N 3RD ST | ||||||||
| Address2: | STE 4000 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142884513 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1350 STARDUST ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757463400 | ||||||||
| FaxNumber: | 7757463411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | N0236 | TX | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 48296 | AZ | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 15438 | NV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.