Healthcare Provider Details

I. General information

NPI: 1780593665
Provider Name (Legal Business Name): SANCTUARY BEHAVIORAL CARE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 N 1ST ST STE 511
FRESNO CA
93720-0989
US

IV. Provider business mailing address

455 MARKET ST SUITE 1940 #561767
SAN FRANCISCO CA
94105
US

V. Phone/Fax

Practice location:
  • Phone: 559-696-6968
  • Fax:
Mailing address:
  • Phone: 559-696-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMMANUEL FANTONE
Title or Position: OWNER
Credential: MD
Phone: 559-696-6968