Provider Demographics
NPI:1639849284
Name:WONGK, BELEN ANZALDO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:ANZALDO
Last Name:WONGK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:BELEN
Other - Middle Name:LISET
Other - Last Name:ANZALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13670 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2422
Mailing Address - Country:US
Mailing Address - Phone:424-789-2670
Mailing Address - Fax:
Practice Address - Street 1:333 W BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4438
Practice Address - Country:US
Practice Address - Phone:562-491-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health