Healthcare Provider Details

I. General information

NPI: 1063473015
Provider Name (Legal Business Name): JANE Y FONG, PHD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SPRING ST STE A
PASO ROBLES CA
93446-1617
US

IV. Provider business mailing address

1818 SPRING ST STE A
PASO ROBLES CA
93446-1617
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-9595
  • Fax: 805-239-9119
Mailing address:
  • Phone: 805-239-9595
  • Fax: 805-239-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15121
License Number StateCA

VIII. Authorized Official

Name: DR. JANE Y FONG
Title or Position: PRACTICE DIRECTOR/PSYCHOLOGIST
Credential: PHD
Phone: 805-239-9595