Provider Demographics
NPI:1174656789
Name:WONG, CATHERINE (RN-NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17134 COLIMA RD STE E
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6737
Mailing Address - Country:US
Mailing Address - Phone:626-820-0603
Mailing Address - Fax:626-820-0602
Practice Address - Street 1:17134 COLIMA RD STE E
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6737
Practice Address - Country:US
Practice Address - Phone:626-820-0603
Practice Address - Fax:626-820-0602
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN507738163W00000X
CANP11905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN507738Medicaid
CAWNP11905AMedicare ID - Type Unspecified
CAQ31615Medicare UPIN