MEDICARE: FANTASIA FONTES

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1982550703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FANTASIA FONTES

Provider Business Mailing Address
First Line	:	3525 BRINKMORE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1337
Country	:	US
Telephone Number	:	234-425-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 BRINKMORE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1337
Country	:	US
Telephone Number	:	234-425-3477
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ FANTASIA FONTES ” Practice Location

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