Provider Demographics
NPI:1659434827
Name:FONTOURA, ANA LUCIA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LUCIA
Last Name:FONTOURA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MOORPARK AVE
Mailing Address - Street 2:APT . 108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-4102
Mailing Address - Country:US
Mailing Address - Phone:408-366-4212
Mailing Address - Fax:408-366-4201
Practice Address - Street 1:4020 MOORPARK AVE
Practice Address - Street 2:APT . 108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-4102
Practice Address - Country:US
Practice Address - Phone:408-366-4212
Practice Address - Fax:408-366-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35245OtherLMFT