MEDICARE: TAVIA I FONTENOT

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1700616463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVIA I FONTENOT

Provider Business Mailing Address
First Line	:	30039 SWAN POINT DR
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-7407
Country	:	US
Telephone Number	:	951-796-3840
Fax Number	:

Provider Business Practice Location Address
First Line	:	30039 SWAN POINT DR
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-7407
Country	:	US
Telephone Number	:	951-796-3840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

Similar Medicare Providers

1659078582 — MR. WILLIAM W EVERLY JR. CARE PROVIDER
Practice Location Address:

30051 SWAN POINT DR
CANYON LAKE, CA
92587-7407

Practice Phone: 949-212-8851
Practice Fax: 949-481-3197

1538163506 — DR. DANIEL WAYNE ROSS M.D.
Practice Location Address:

1408 LAKE RIDGE SQ
JOHNSON CITY, TN
37601-7407

Practice Phone: 423-782-6848
Practice Fax: 423-283-4797

1679568240 — RADCLIFFE JONES M.D.
Practice Location Address:

2320 WALTON LAKE DR
KOKOMO, IN
46902-7407

Practice Phone: 765-437-0211
Practice Fax:

1235638412 — MALIBU COMPANION SERVICES, LLC
Practice Location Address:

7407 COCOANUT DR
LAKE WORTH, FL
33467-6421

Practice Phone: 770-873-6303
Practice Fax: 678-625-2662

1215891049 — GA SOUTHERN DENTAL PPO
Practice Location Address:

7407 N LAKE LOOP
COLUMBUS, GA
31909-2577

Practice Phone: 706-323-8811
Practice Fax:

1558228031 — DOZIER SURGICAL LLC
Practice Location Address:

6046 OCEANAIRE WAY
LAKE WORTH, FL
33467-7407

Practice Phone: 954-674-6474
Practice Fax:

Directions to “ TAVIA I FONTENOT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.