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General NPI Number Information
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NPI Number | 1922236165
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Entity Type | Individual
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Provider Name | ROBERT LARA TONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 101 BODIN CIR
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-799-7947
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Fax |
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Provider Business Mailing Address
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Address Line | 801 D ST APT 22
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City | DAVIS
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State | CA
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Zip | 95616-2288
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Country | US
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Telephone | 858-232-9032
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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