Healthcare Provider Details

I. General information

NPI: 1932020591
Provider Name (Legal Business Name): ANNE MARIE FONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE MARIE FERRON

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 AVENIDA PICO STE 201
SAN CLEMENTE CA
92673-6356
US

IV. Provider business mailing address

21022 LOS ALISOS BLVD APT 821
RANCHO SANTA MARGARITA CA
92688-3252
US

V. Phone/Fax

Practice location:
  • Phone: 949-388-8788
  • Fax:
Mailing address:
  • Phone: 813-965-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: