Basic Information
| Provider Information | |||||||||
| NPI: | 1477728046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRATANTONIO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | MARIO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1543 N VALLEY ST | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915052001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179397003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 N OCCIDENTAL BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900264641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133812931 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.