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General NPI Number Information
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NPI Number | 1861888018
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Entity Type | Individual
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Provider Name | DANIELA FANTO MBBS
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 3311 N HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60657-2412
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Country | US
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Telephone | 773-435-9994
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Fax | 833-734-1443
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-860-5200
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Fax | 323-467-7119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036154021
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License Number State | IL
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