Healthcare Provider Details

I. General information

NPI: 1619751930
Provider Name (Legal Business Name): NATALIE MICHELLE WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 216
SANTA ANA CA
92705-6506
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE ANDL805
IRVINE CA
92612-2452
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax:
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA64880
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: