Healthcare Provider Details

I. General information

NPI: 1447003801
Provider Name (Legal Business Name): COLE FONTES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 PEARL ST
MONTEREY CA
93940-3070
US

IV. Provider business mailing address

3768 VISTA DR
SOQUEL CA
95073-2325
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax:
Mailing address:
  • Phone: 831-431-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95345163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: