Provider Demographics
NPI:1902212533
Name:FONTES, ILIANA DANIELLA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:DANIELLA
Last Name:FONTES
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:ILIANA
Other - Middle Name:DANIELLA
Other - Last Name:ARANGUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4324
Mailing Address - Country:US
Mailing Address - Phone:310-719-3908
Mailing Address - Fax:
Practice Address - Street 1:1411 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4324
Practice Address - Country:US
Practice Address - Phone:310-719-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 76395101YM0800X
106E00000X
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health