Provider Demographics
NPI:1073496469
Name:FONT, SPENCER RAE (PMHNP-BC, CPEN)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:RAE
Last Name:FONT
Suffix:
Gender:F
Credentials:PMHNP-BC, CPEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BAY ST APT B1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1331
Mailing Address - Country:US
Mailing Address - Phone:775-287-3608
Mailing Address - Fax:
Practice Address - Street 1:150 UCLA MEDICAL PLAZA
Practice Address - Street 2:RNPH 4-EAST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-267-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034324363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health