Provider Demographics
NPI:1871763367
Name:FONG, MAOLING (MFTI)
Entity type:Individual
Prefix:
First Name:MAOLING
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:MAOLING
Other - Middle Name:FONG
Other - Last Name:STANDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:81 840 AVENUE 46
Mailing Address - Street 2:#201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-391-6975
Mailing Address - Fax:
Practice Address - Street 1:81 840 AVE 46
Practice Address - Street 2:#201
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-391-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF55232171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator