Individual
AUDRA WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
510 SUPERIOR AVE, NEWPORT BEACH, CA 92663-3663
(800) 400-4624
Mailing address
510 SUPERIOR AVE, NEWPORT BEACH, CA 92663-3663
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95013262
CA
Other
Enumeration date
03/17/2020
Last updated
09/23/2022
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