Provider Demographics
NPI:1871532655
Name:NG, VERONICA MANWAI (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MANWAI
Last Name:NG
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 1:1200 SONOMA AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6664
Mailing Address - Country:US
Mailing Address - Phone:707-575-8570
Mailing Address - Fax:707-575-5014
Practice Address - Street 1:1200 SONOMA AVE
Practice Address - Street 2:STE. 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6664
Practice Address - Country:US
Practice Address - Phone:707-575-8570
Practice Address - Fax:707-575-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72891OtherCA STATE LICENSE NUMBER
CAZZZ23128ZOtherMEDICARE GROUP ID NUMBER
CAG72891OtherCA STATE LICENSE NUMBER