Basic Information
| Provider Information | |||||||||
| NPI: | 1922390723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELIZABETH WONG, CRNA APNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2603 KIRSTEN LEE DR | ||||||||
| Address2: | |||||||||
| City: | WESTLAKE VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913615573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186203692 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Practice Location | |||||||||
| Address1: | 10760 WARNER AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927083845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186203692 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8186203692 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | NA2435 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.