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Individual
CLARISSE MELINDA FONG SAN JUAN
Active
Individual
CLARISSE MELINDA FONG SAN JUAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
72590
CT
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
72590
CT
Other
Enumeration date
06/22/2017
Last updated
08/18/2023
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