Individual
DR. HENRY LOREN FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 N MCDOWELL BLVD, PETALUMA, CA 94954-2339
(707) 778-1111
Mailing address
400 N MCDOWELL BLVD, PETALUMA, CA 94954-2339
(707) 778-1111
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
G69103
CA
Other
Enumeration date
07/13/2006
Last updated
04/14/2011
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