Individual
ANTHONY WONG PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
835 W CHRISTOPHER ST, WEST COVINA, CA 91790-3702
(626) 943-7772
Mailing address
9060 HUNTINGTON DR, SAN GABRIEL, CA 91775-1332
(626) 943-7772
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-54001
CA
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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