Healthcare Provider Details

I. General information

NPI: 1093883654
Provider Name (Legal Business Name): FONTANA ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 DALY ST
LOS ANGELES CA
90031-2230
US

IV. Provider business mailing address

2309 DALY ST
LOS ANGELES CA
90031-2230
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-8149
  • Fax: 323-276-8143
Mailing address:
  • Phone: 323-276-8149
  • Fax: 323-276-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ANTONIO ZAMORANO
Title or Position: CFO
Credential:
Phone: 323-276-8149