Provider Demographics
NPI:1558438655
Name:FONTENOT, ALFRED PAUL (LPT)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:PAUL
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 MARKET ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1706
Mailing Address - Country:US
Mailing Address - Phone:415-597-8028
Mailing Address - Fax:415-597-8004
Practice Address - Street 1:939 MARKET ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1706
Practice Address - Country:US
Practice Address - Phone:415-597-8028
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15046247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other