Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 11826131-1205 | UT |
NPI | 1154680650 |
---|---|
Provider Name | Dr. Vanessa Wong |
First Address | Orange, CA 92868-4509 |
Second Address | Orange, CA 92868-4509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 23/11/2021 |