Provider Demographics
NPI:1619269974
Name:LELENTA, FATOUMATA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATOUMATA
Middle Name:
Last Name:LELENTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 VISTA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2485
Mailing Address - Country:US
Mailing Address - Phone:415-269-3997
Mailing Address - Fax:
Practice Address - Street 1:333 MERCY AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8319
Practice Address - Country:US
Practice Address - Phone:209-564-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119224207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine