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Dr. Calbert A Wong

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NPI Number Detailed Information

Provider Information:

Name: Dr. Calbert A Wong
Gender: M
Provider License Number If Given: A52812

NPI Information:

NPI: 1902805294
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/19/2005

Last Update Date: 4/8/2016

Provider Business Mailing Address:

Address: 2125 KNOLL DR SUITE # 104
Ventura, CA 93003
Phone Number: 8052567810
Fax Number: 8052567840

Provider Business Practice Location Address:

Address: 2438 N PONDEROSA DR # C-101
Camarillo, CA 93010
Phone Number: 8053839727
Fax Number: 8057640176

Provider Taxonomy:

Primary: 207RN0300X
Secondary (if any):
State: CA

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