Healthcare Provider Details

I. General information

NPI: 1740928563
Provider Name (Legal Business Name): LIA FONTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 GENEVA DR
OVIEDO FL
32765-6757
US

IV. Provider business mailing address

745 ORIENTA AVE STE 1011
ALTAMONTE SPRINGS FL
32701-5675
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax: 352-332-8589
Mailing address:
  • Phone: 877-823-4283
  • Fax: 352-332-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16550
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: