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General NPI Number Information
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NPI Number | 1992133524
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Entity Type | Individual
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Provider Name | KIRSTEN FANTZ L.P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 3636 N 1ST ST 162; 135
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City | FRESNO
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State | CA
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Zip | 93726-6800
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Country | US
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Telephone | 559-221-1107
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Fax | 559-221-5004
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Provider Business Mailing Address
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Address Line | 3636 N 1ST ST 162; 135
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City | FRESNO
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State | CA
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Zip | 93726-6800
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Country | US
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Telephone | 559-221-1107
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Fax | 559-221-5004
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 37243
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License Number State | CA
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