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General NPI Number Information
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NPI Number | 1346313459
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Entity Type | Individual
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Provider Name | SHIRLEY PATRICIA WONG DO
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE DEPT WOMEN'S HEALTH, 2ND FLOOR, MOB
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-3470
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Fax | 909-580-6369
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Provider Business Mailing Address
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Address Line | 400 N PEPPER AVE DEPT WOMEN'S HEALTH, 2ND FLOOR, MOB
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-3470
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Fax | 909-580-6369
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 20A8691
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License Number State | CA
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