MEDICARE: MELANIE FORTINO

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	101YS0200X	School Counselor	3902912	AZ

General Provider Information

NPI Number	:	1336473040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE FORTINO

Provider Business Mailing Address
First Line	:	19871 W FREEMONT RD
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-474-6671
Fax Number	:	623-474-6669

Provider Business Practice Location Address
First Line	:	19871 W FREEMONT RD
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-474-6671
Fax Number	:	623-474-6669

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

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	09/28/2009

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Directions to “ MELANIE FORTINO ” Practice Location

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