Healthcare Provider Details

I. General information

NPI: 1194593285
Provider Name (Legal Business Name): JONATHAN FONTANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 N 1ST ST STE 103
FRESNO CA
93710-5400
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-4300
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC22486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: