Individual
DIANA WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3364 BEYER BLVD, SAN YSIDRO, CA 92173-1322
(619) 662-4100
Mailing address
3364 BEYER BLVD, SAN YSIDRO, CA 92173-1322
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTA1186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A6738697
PATIEN PORTAL
CA
Enumeration date
09/21/2022
Last updated
09/21/2022
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