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General NPI Number Information
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NPI Number | 1538481692
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Entity Type | Individual
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Provider Name | DIANA LAM-WONG FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY DR. STUDENT HEALTH SERVICES
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4105
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Country | US
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Telephone | 949-480-4143
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Fax | 949-480-4246
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Provider Business Mailing Address
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Address Line | 46 SAINT CROIX
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5194
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Country | US
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Telephone | 949-363-8104
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP9623
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License Number State | CA
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