Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E4482 | CA |
NPI | 1558575548 |
---|---|
Provider Name | Christina C Fong |
First Address | Rancho Palos Verdes, CA 90275-1216 |
Second Address | Harbor City, CA 90710-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |