Individual
ILIANA DANIELLA FONTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT INTERN
Contact information
Practice address
1411 W 190TH ST, GARDENA, CA 90248-4324
(310) 719-3908
Mailing address
1411 W 190TH ST, GARDENA, CA 90248-4324
(310) 719-3908
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IMF 76395
CA
106E00000X
Assistant Behavior Analyst
Primary
—
CA
106E00000X
Assistant Behavior Analyst
—
—
Other
Enumeration date
07/02/2014
Last updated
01/02/2024
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