Provider Demographics
NPI:1386726347
Name:FONE, KATHRYN ELAINE (DPM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELAINE
Last Name:FONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:E
Other - Last Name:FONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2750 N TEXAS ST
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1290
Mailing Address - Country:US
Mailing Address - Phone:707-422-6642
Mailing Address - Fax:707-447-2163
Practice Address - Street 1:2750 N TEXAS ST
Practice Address - Street 2:STE 230
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1290
Practice Address - Country:US
Practice Address - Phone:707-422-6642
Practice Address - Fax:707-447-2163
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3636213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36360Medicaid
CA000E36360Medicare ID - Type Unspecified
CA000E36360Medicaid