Provider Demographics
NPI:1023297033
Name:WONG, AMBER M (RN, PHN)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7329
Mailing Address - Country:US
Mailing Address - Phone:805-578-1112
Mailing Address - Fax:805-578-1114
Practice Address - Street 1:2125 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7329
Practice Address - Country:US
Practice Address - Phone:805-578-1112
Practice Address - Fax:805-578-1114
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252788171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator