Provider Demographics
NPI:1518243369
Name:FONTANARES, SYDNEY FLORES
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:FLORES
Last Name:FONTANARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 LOGSDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1050
Mailing Address - Country:US
Mailing Address - Phone:408-593-4092
Mailing Address - Fax:
Practice Address - Street 1:2506 LOGSDEN WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1050
Practice Address - Country:US
Practice Address - Phone:408-593-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical