Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | Q0206 | TX |
NPI | 1245551332 |
---|---|
Provider Name | Angelique Wong |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2010 |
Last Update Date | 20/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
341474001 | (05) | TX |