Healthcare Provider Details

I. General information

NPI: 1306110911
Provider Name (Legal Business Name): CECILIA FONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10317 SAN PABLO AVE
EL CERRITO CA
94530-3113
US

IV. Provider business mailing address

10317 SAN PABLO AVE
EL CERRITO CA
94530-3113
US

V. Phone/Fax

Practice location:
  • Phone: 510-528-9950
  • Fax: 510-528-9960
Mailing address:
  • Phone: 510-528-9950
  • Fax: 510-528-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: