MEDICARE: AMBER LEANNE WONG

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1932802584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LEANNE WONG

Provider Business Mailing Address
First Line	:	21247 STOCKTON PASS RD
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-5110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21247 STOCKTON PASS RD
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-5110
Country	:	US
Telephone Number	:	909-270-0270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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Directions to “ AMBER LEANNE WONG ” Practice Location

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