Healthcare Provider Details

I. General information

NPI: 1184139792
Provider Name (Legal Business Name): MICHELLE DONGLANG WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 CROW CANYON RD STE 101
SAN RAMON CA
94583-1659
US

IV. Provider business mailing address

411 OAK CREST PL
PITTSBURG CA
94565-7372
US

V. Phone/Fax

Practice location:
  • Phone: 510-999-4410
  • Fax:
Mailing address:
  • Phone: 925-876-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: