Provider Demographics
NPI:1972645778
Name:FONTENOT, JANEANN
Entity Type:Individual
Prefix:MS
First Name:JANEANN
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKSIDE COMMUNITY HEALTH CENTER
Mailing Address - Street 2:2023 VALE ROAD, SUITE 107
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3834
Mailing Address - Country:US
Mailing Address - Phone:510-231-9819
Mailing Address - Fax:510-412-9867
Practice Address - Street 1:BROOKSIDE COMMUNITY HEALTH CENTER
Practice Address - Street 2:2023 VALE ROAD, SUITE 107
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-231-9819
Practice Address - Fax:510-412-9867
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife