Provider Demographics
NPI:1821671892
Name:WILFONG, JOY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:
Last Name:WILFONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23845 HOLMAN HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5901
Mailing Address - Country:US
Mailing Address - Phone:831-241-9155
Mailing Address - Fax:
Practice Address - Street 1:23845 HOLMAN HWY STE 203
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5901
Practice Address - Country:US
Practice Address - Phone:831-241-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant