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NPI Code Detail

MEDICARE: ALYSSA GUILLORY FONG MD

MEDICARE: ALYSSA GUILLORY FONG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730982448
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA GUILLORY FONG MD
Provider Business Mailing Address
First Line : 2390 W CONGRESS ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-4205
Country : US
Telephone Number : 225-636-1777
Fax Number :
Provider Business Practice Location Address
First Line : 2390 W CONGRESS ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-4205
Country : US
Telephone Number : 225-636-1777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2025
Last Update Date : 12/02/2025

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