Provider Demographics
NPI:1598297798
Name:OFONG, MFON (NP)
Entity Type:Individual
Prefix:
First Name:MFON
Middle Name:
Last Name:OFONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3806
Mailing Address - Country:US
Mailing Address - Phone:361-885-0010
Mailing Address - Fax:361-885-0001
Practice Address - Street 1:613 ELIZABETH ST STE 704
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-885-0010
Practice Address - Fax:361-885-0001
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily