MEDICARE: DR. VINCENT M FORTANASCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A25976	CA

General Provider Information

NPI Number	:	1104833052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT M FORTANASCE M.D.

Provider Business Mailing Address
First Line	:	665 W NAOMI AVE STE 201
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:	626-445-8481
Fax Number	:	626-574-9669

Provider Business Practice Location Address
First Line	:	665 W NAOMI AVE STE 201
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7563
Country	:	US
Telephone Number	:	626-445-8481
Fax Number	:	626-574-9669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/07/2011

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