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General NPI Number Information
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NPI Number | 1649480039
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Entity Type | Individual
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Provider Name | AMANDA C. WONGSONEGORO CMT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 35 PETALUMA BLVD N
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City | PETALUMA
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State | CA
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Zip | 94952-3001
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Country | US
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Telephone | 707-477-5402
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Fax | 707-762-4316
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Provider Business Mailing Address
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Address Line | 332 KEOKUK ST
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City | PETALUMA
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State | CA
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Zip | 94952-2729
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Country | US
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Telephone | 707-762-4316
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Fax | 707-762-4316
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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