Basic Information
| Provider Information | |||||||||
| NPI: | 1871632547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANTONE | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2288 FULTON ST | ||||||||
| Address2: | STE 309 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594326234 | ||||||||
| FaxNumber: | 5594360677 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 W HERNDON AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937110552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592562000 | ||||||||
| FaxNumber: | 5592563000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 03/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A61907 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 49146 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.