=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841820875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA C WONG PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2020
-----------------------------------------------------
Last Update Date | 02/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8350 BEE RIDGE RD # 288
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34241-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-215-8090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8360 BEE RIDGE RD # 288
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34241-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AURORA C WONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-315-8090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------