MEDICARE: JANE Y FONG, PHD & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY15121	CA

General Provider Information

NPI Number	:	1063473015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE Y FONG, PHD & ASSOCIATES

Provider Business Mailing Address
First Line	:	1818 SPRING ST STE A
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1617
Country	:	US
Telephone Number	:	805-239-9595
Fax Number	:	805-239-9119

Provider Business Practice Location Address
First Line	:	1818 SPRING ST STE A
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1617
Country	:	US
Telephone Number	:	805-239-9595
Fax Number	:	805-239-9119

Authorized Official
Title or Position	:	PRACTICE DIRECTOR/PSYCHOLOGIST
Name	:	DR. JANE Y FONG
Credential	:	PHD
Telephone Number	:	805-239-9595

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	05/14/2009

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