Individual
MRS. LILLY FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
11370 ANDERSON ST, LOMA LINDA, CA 92354-3450
(909) 558-2840
Mailing address
11370 ANDERSON ST STE 1100, LOMA LINDA, CA 92354-3450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95013904
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
95013904
CA
363LA2200X
Adult Health Nurse Practitioner
NP95013904
CA
363LG0600X
Gerontology Nurse Practitioner
95013904
CA
Other
Enumeration date
05/09/2020
Last updated
02/03/2026
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