Individual
MRS. AMANDA C. WONGSONEGORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
35 PETALUMA BLVD N, PETALUMA, CA 94952-3001
(707) 477-5402
(707) 762-4316
Mailing address
332 KEOKUK ST, PETALUMA, CA 94952-2729
(707) 762-4316
(707) 762-4316
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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