Healthcare Provider Details

I. General information

NPI: 1235409624
Provider Name (Legal Business Name): INGRID WILSON HUANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 PARKER RD
CANTONMENT FL
32533
US

IV. Provider business mailing address

2220 PARKER RD
CANTONMENT FL
32533-8177
US

V. Phone/Fax

Practice location:
  • Phone: 858-699-4640
  • Fax:
Mailing address:
  • Phone: 858-699-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1626
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: