Provider Information for 1992855191
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Mr. ANTONIO WONG-RIVADENEYRA LCSW
Sex: Male
NPI: 1992855191
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1992855191 | ||||||||
| Enumeration Date | 2007-01-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1761 BROADWAY SUITE 100 VALLEJO, CA 94589-2226 United States Phone: 707-645-2341 | Fax:707-645-2181 | ||||||||
| Primary Practice Address | 1761 BROADWAY SUITE 100 VALLEJO, CA 94589-2226 United States Phone: 707-645-2341 | Fax:707-645-2181 | ||||||||
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