MEDICARE: DR. MICHAEL FENTON PHD

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	103TC0700X	Clinical Psychologist	PSY9254	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881654846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FENTON PHD

Provider Business Mailing Address
First Line	:	1000 QUAIL ST
Second Line	:	SUITE 170
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2731
Country	:	US
Telephone Number	:	949-833-7933
Fax Number	:	949-833-3963

Provider Business Practice Location Address
First Line	:	1000 QUAIL ST
Second Line	:	SUITE 170
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2839
Country	:	US
Telephone Number	:	949-833-7933
Fax Number	:	949-833-3963

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	09/11/2008

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Directions to “ DR. MICHAEL FENTON PHD” Practice Location

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