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General NPI Number Information
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NPI Number | 1801939269
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Entity Type | Organization
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Legal Business Name | CYRIL C WONG LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 11009 HEARTH RD
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City | SPRING HILL
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State | FL
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Zip | 34608-3723
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Country | US
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Telephone | 352-688-5700
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Fax | 352-688-5548
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Provider Business Mailing Address
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Address Line | PO BOX 15430
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City | BROOKSVILLE
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State | FL
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Zip | 34604-0118
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Country | US
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Telephone | 352-597-7373
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Fax | 352-597-7368
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELANA WONG
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Credential |
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Telephone | 352-688-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME66960
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License Number State | FL
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