Provider Demographics
NPI:1063638955
Name:FUMANTI, JESSICA (BHSII)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:FUMANTI
Suffix:
Gender:F
Credentials:BHSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 SOUTH STATE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583
Mailing Address - Country:US
Mailing Address - Phone:951-791-3122
Mailing Address - Fax:951-791-3397
Practice Address - Street 1:1370 S STATE ST # B
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4933
Practice Address - Country:US
Practice Address - Phone:951-791-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator