Doctor Name: | MRS. AMANDA C. WONGSONEGORO |
NPI Number: | 1649480039 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CMT |
License Number: | |
Business Practice Address: | 35 Petaluma Blvd N Petaluma, CA - 949523001 |
Business Phone Number: | 7074775402 |
Business Fax Number: | 7077624316 |
Mailing Address: | 332 Keokuk St, PETALUMA |
State: | CA |
Postal Code: | 949522729 |
Phone Number: | 7077624316 |
Fax Number: | 7077624316 |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |