Healthcare Provider Details

I. General information

NPI: 1649505827
Provider Name (Legal Business Name): ANNA MYRA WONG LAZARO RDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29270 UNION CITY BLVD
UNION CITY CA
94587-1209
US

IV. Provider business mailing address

29270 UNION CITY BLVD
UNION CITY CA
94587-1209
US

V. Phone/Fax

Practice location:
  • Phone: 510-475-5882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD7385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: