Healthcare Provider Details

I. General information

NPI: 1114145190
Provider Name (Legal Business Name): FONDAS THERAPY BILLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 W ALLEN ST
BRAWLEY CA
92227-3101
US

IV. Provider business mailing address

259 W ALLEN ST
BRAWLEY CA
92227-3101
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-2764
  • Fax: 760-344-8240
Mailing address:
  • Phone: 760-344-2764
  • Fax: 760-344-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: FONDA K HOWINGTON
Title or Position: OWNER
Credential:
Phone: 760-344-2764