# JESSICA WONG NURSE PRACTITIONER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417721770
- **Authorized official:** JESSICA WONG (NP)
- **Authorized official phone:** (714) 457-9905

## Contact information

- **Practice address:** 15024 IMPERIAL HWY, LA MIRADA, CA 90638-1301
- **Practice address phone:** (714) 457-9905
- **Mailing address:** 15024 IMPERIAL HWY, LA MIRADA, CA 90638-1301
- **Mailing address phone:** (714) 457-9905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2023
- **Last updated:** 07/11/2024