1861710675 NPI number — DR. DAVID LAWRENCE FONTES PSY.D.

Table of content: DR. DAVID LAWRENCE FONTES PSY.D. (NPI 1861710675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861710675 NPI number — DR. DAVID LAWRENCE FONTES PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTES
Provider First Name:
DAVID
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861710675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8841 WILLIAMSON DR
Provider Second Line Business Mailing Address:
SUITE 40
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-685-5258
Provider Business Mailing Address Fax Number:
916-653-0782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8841 WILLIAMSON DR
Provider Second Line Business Practice Location Address:
SUITE 40
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-685-5258
Provider Business Practice Location Address Fax Number:
916-653-0782
Provider Enumeration Date:
05/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY#18439 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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