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Individual

ACQUENETTA DIANE SUMMERS-WONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
55 E 18TH ST, ANTIOCH, CA 94509-2450
(925) 777-1133
Mailing address
55 E 18TH ST, ANTIOCH, CA 94509-2450
(925) 777-1133

Taxonomy

Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
95106500
CA

Other

Enumeration date
05/01/2017
Last updated
05/01/2017
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