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General NPI Number Information
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NPI Number | 1205082369
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Entity Type | Organization
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Legal Business Name | WONG CENTER INC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 19969 GREENLEY RD SUITE G
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City | SONORA
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State | CA
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Zip | 95370-5908
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Country | US
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Telephone | 209-532-0300
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Fax | 209-532-0310
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Provider Business Mailing Address
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Address Line | 19969 GREENLEY RD SUITE G
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City | SONORA
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State | CA
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Zip | 95370-5908
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Country | US
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Telephone | 209-532-0300
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Fax | 209-532-0310
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DEBORAH WONG
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Credential | MD
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Telephone | 209-532-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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