Organization Name: | CARMEN P WONG, MD, PA |
NPI Number: | 1477848877 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MONICA M ALVAREZ (OFFICE MANAGER) |
Mailing Address: | 15055 East Fwy B50 Channelview |
State: | TX US |
Postal Code: | 775304144 |
Phone Number: | 2814571212 |
Fax Number: | 2814571223 |
NPI Enumeration Date: | 06/14/2011 |
NPI Last Update Date: | 08/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | J3003 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |