Provider Demographics
NPI:1962732974
Name:FONTE, NANETTE CHUA (MD)
Entity type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:CHUA
Last Name:FONTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2768
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2768
Mailing Address - Country:US
Mailing Address - Phone:661-948-1388
Mailing Address - Fax:661-948-1223
Practice Address - Street 1:1759 W AVENUE J
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2703
Practice Address - Country:US
Practice Address - Phone:661-948-1388
Practice Address - Fax:661-948-1223
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111173207RN0300X
MIL602138207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA111173Medicare UPIN
CAGR0089250Medicaid
CAA111173Medicare UPIN
CA553955Medicare Oscar/Certification