Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 130621 | CA |
NPI | 1225146616 |
---|---|
Provider Name | Dr. Myra Wong |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 12/06/2018 |