Healthcare Provider Details

I. General information

NPI: 1104046762
Provider Name (Legal Business Name): DR. LIZA WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE WASHINGTON HOSPITAL. DEPT OF PHARMACY
FREMONT CA
94538-1716
US

IV. Provider business mailing address

3711 ROSE ROCK CIR
PLEASANTON CA
94588-8371
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-3495
  • Fax:
Mailing address:
  • Phone: 925-846-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number52545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: