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General NPI Number Information
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NPI Number | 1871632547
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Entity Type | Individual
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Provider Name | EMMANUEL J FANTONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 21900 BURBANK BLVD STE 300
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-7418
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Country | US
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Telephone | 818-992-3121
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Fax | 888-959-5641
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Provider Business Mailing Address
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Address Line | 2778 E ECLIPSE AVE
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City | FRESNO
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State | CA
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Zip | 93720-5475
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Country | US
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Telephone | 559-696-6968
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Fax | 559-354-0167
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 49146
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A61907
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License Number State | CA
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