Healthcare Provider Details

I. General information

NPI: 1801939269
Provider Name (Legal Business Name): CYRIL C WONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11009 HEARTH RD
SPRING HILL FL
34608-3723
US

IV. Provider business mailing address

PO BOX 15430
BROOKSVILLE FL
34604-0118
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-5700
  • Fax: 352-688-5548
Mailing address:
  • Phone: 352-597-7373
  • Fax: 352-597-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66960
License Number StateFL

VIII. Authorized Official

Name: MRS. ELANA WONG
Title or Position: PRESIDENT
Credential:
Phone: 352-688-5700