Provider Demographics
NPI:1265648844
Name:FORT, ANTOINETTE M
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:M
Last Name:FORT
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 1:340 HAMILTON ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1463
Mailing Address - Country:US
Mailing Address - Phone:415-374-3135
Mailing Address - Fax:
Practice Address - Street 1:2500 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2109
Practice Address - Country:US
Practice Address - Phone:415-546-6756
Practice Address - Fax:415-546-6778
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator