Provider Demographics
NPI:1780701151
Name:FONTWIT, KATHRYN (PA)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:FONTWIT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE BLDG 100 RM 350
Mailing Address - Street 2:SFGH RENAL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8242
Mailing Address - Fax:415-285-2389
Practice Address - Street 1:1001 POTRERO AVE BLDG 100 RM 350
Practice Address - Street 2:SFGH RENAL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8242
Practice Address - Fax:415-285-2389
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
059758OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
059758OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER