Provider Demographics
NPI:1629288998
Name:NABONG, TEDDIE MONT
Entity Type:Individual
Prefix:
First Name:TEDDIE
Middle Name:MONT
Last Name:NABONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3026
Mailing Address - Country:US
Mailing Address - Phone:562-437-0831
Mailing Address - Fax:562-628-9393
Practice Address - Street 1:1250 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3026
Practice Address - Country:US
Practice Address - Phone:562-437-0831
Practice Address - Fax:562-628-9393
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18330208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation