Provider Demographics
NPI:1689857229
Name:FONT, SUSAN AMANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMANDA
Last Name:FONT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5901 WARNER AVE
Mailing Address - Street 2:342
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4659
Mailing Address - Country:US
Mailing Address - Phone:562-595-0060
Mailing Address - Fax:562-595-0027
Practice Address - Street 1:18111 BROOKHURST ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-963-7240
Practice Address - Fax:714-963-7224
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19469363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical