Individual
DR. JACQUELINE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16756 CHINO CORONA RD, CORONA, CA 92880-9508
(909) 772-9434
Mailing address
PO BOX 55360, RIVERSIDE, CA 92517-0360
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G051742
CA
Other
Enumeration date
07/18/2007
Last updated
07/18/2007
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