Sidney Lakusta-Wong
Pediatrics in Phoenix, AZ. Individual provider (NPI-1).
NPI number1346730751
StatusActive
Last updated in NPPESFeb 24, 2023
Details
- NPI
- 1346730751
- Entity type
- Individual (NPI-1)
- Name
- Sidney Lakusta-Wong
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 11, 2018
- Certification date
- Feb 24, 2023
- Last updated
- Feb 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | 68487 | AZ | Yes |
| 208000000X | Pediatrics | A163866 | CA |
Practice location
2601 E Roosevelt StPhoenix, AZ 85008-4973
Phone 602-344-5011
Mailing address
2929 E Thomas RdPhoenix, AZ 85016-8034
Phone 602-470-5000
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