MR. Luis Gustavo Fong, MSED

NPI #1508155862 in Corona, New York

Provider Information

NPI Number: 1508155862
Entity Type: Individual
Name: MR. Luis Gustavo Fong, MSED
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: MSED
Enumeration Date: Apr 7, 2011
Last Updated: Jul 21, 2022

Practice Location

Address: 9834 ALSTYNE AVE
Address 2: FLOOR 2
City: Corona
State: New York
ZIP Code: 11368-2720
Phone: (917) 279-7644

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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