Healthcare Provider Details

I. General information

NPI: 1376614057
Provider Name (Legal Business Name): PATRICIA WONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S CEDAR AVE
FRESNO CA
93702-2907
US

IV. Provider business mailing address

4910 E CLINTON WAY SUITE 101
FRESNO CA
93727-1560
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-5105
  • Fax:
Mailing address:
  • Phone: 559-453-5203
  • Fax: 559-453-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF6101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: