Organization
V. VONGTAMA MD INC
Active
Other names
St. Teresa Comprehensive Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITUNE VONGTAMA M.D. (OWNER)
(209) 472-1848
Entity
Organization
Contact information
Practice address
4722 QUAIL LAKES DR, STOCKTON, CA 95207-5244
(209) 472-1848
(209) 472-0133
Mailing address
4722 QUAIL LAKES DR, STOCKTON, CA 95207-5244
(209) 472-1848
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
A29753
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A297530
—
CA
Enumeration date
02/08/2007
Last updated
08/21/2014
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