Healthcare Provider Details

I. General information

NPI: 1326004581
Provider Name (Legal Business Name): VALERIE LEE WONG R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

2219 E SOLAR AVE
FRESNO CA
93720-4608
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4000
  • Fax: 559-324-3748
Mailing address:
  • Phone: 559-324-4731
  • Fax: 559-324-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number709327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: