Healthcare Provider Details

I. General information

NPI: 1083696603
Provider Name (Legal Business Name): RODOLFO DE LOSSANTOS ONGJOCO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RODOLFO S. ONGJOCO JR. MD

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PERRY DR
SOUTHERN PINES NC
28387-7020
US

IV. Provider business mailing address

180 PERRY DR
SOUTHERN PINES NC
28387-7020
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-0567
  • Fax: 910-246-0669
Mailing address:
  • Phone: 910-246-0567
  • Fax: 910-246-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9500170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: