# FONTANA CARDIOVASCULAR GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649654062
- **Authorized official:** GREG P FONTANA MD (PRESIDENT)
- **Authorized official phone:** (310) 721-2285

## Contact information

- **Practice address:** 8635 WEST THRID STREET, SUITE 750W, LOS ANGELES, CA 90048
- **Practice address phone:** (310) 659-2030
- **Mailing address:** 9663 SANTA MONICA BLVD, NO 756, BEVERLY HILLS, CA 90210-4303
- **Mailing address phone:** (310) 721-2285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2015
- **Last updated:** 07/15/2015