Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 19219 | CA |
NPI | 1003129925 |
---|---|
Provider Name | Claudia L Wong |
First Address | Milpitas, CA 95035-3190 |
Second Address | Santa Monica, CA 90404-2050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2010 |
Last Update Date | 12/10/2020 |