Provider Demographics
NPI:1134709249
Name:FONTORA, PABLO RAUL (PES)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:RAUL
Last Name:FONTORA
Suffix:
Gender:M
Credentials:PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17227 MOUNT STEPHEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3135
Mailing Address - Country:US
Mailing Address - Phone:661-250-4833
Mailing Address - Fax:
Practice Address - Street 1:17227 MOUNT STEPHEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-3135
Practice Address - Country:US
Practice Address - Phone:661-889-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer