Provider Demographics
NPI:1912361569
Name:WONG, BRITTANY ANN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ANN
Other - Last Name:MARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:352 BUENA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-9668
Mailing Address - Country:US
Mailing Address - Phone:760-566-3591
Mailing Address - Fax:760-566-3589
Practice Address - Street 1:352 BUENA CREEK RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-9668
Practice Address - Country:US
Practice Address - Phone:760-566-3591
Practice Address - Fax:760-566-3589
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health