Provider Demographics
NPI:1962983163
Name:DINGONG, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DINGONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 N LOOP 1604 E APT 9204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2092
Mailing Address - Country:US
Mailing Address - Phone:210-740-6943
Mailing Address - Fax:
Practice Address - Street 1:5726 W HAUSMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1651
Practice Address - Country:US
Practice Address - Phone:210-349-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340059164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse