Provider Demographics
NPI:1780734343
Name:FONTANA, LOUIS ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ANTHONY
Last Name:FONTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:678 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5736
Mailing Address - Country:US
Mailing Address - Phone:909-838-3836
Mailing Address - Fax:619-271-0644
Practice Address - Street 1:678 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5736
Practice Address - Country:US
Practice Address - Phone:909-838-3836
Practice Address - Fax:619-271-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49072207LP2900X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17152Medicare UPIN