Healthcare Provider Details

I. General information

NPI: 1043423916
Provider Name (Legal Business Name): TERRY A FONG ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRY A FONG NMD, OT

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 115
FOOTHILL RANCH CA
92610-2843
US

IV. Provider business mailing address

PO BOX 1318
SACRAMENTO CA
95812-1318
US

V. Phone/Fax

Practice location:
  • Phone: 949-844-7374
  • Fax: 949-272-5847
Mailing address:
  • Phone: 949-844-7374
  • Fax: 949-272-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number11-1271
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND301
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: