Individual
MR. MARC WREN FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 573-6127
Mailing address
1446 JELLICK AVE, UNIT E, ROWLAND HEIGHTS, CA 91748-1920
(909) 573-6127
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
759678
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000533
CA
Other
Enumeration date
05/10/2016
Last updated
08/29/2023
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