Provider Demographics
NPI:1992766380
Name:WONG, DOREEN-SIERRA (MD)
Entity type:Individual
Prefix:DR
First Name:DOREEN-SIERRA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N SABINO CAYON ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750
Mailing Address - Country:US
Mailing Address - Phone:520-505-1751
Mailing Address - Fax:740-212-8473
Practice Address - Street 1:5215 N SABINO CANYON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-6435
Practice Address - Country:US
Practice Address - Phone:520-505-1751
Practice Address - Fax:740-212-8473
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA805942084P0800X
AZ427542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA21069Medicare UPIN