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NPI Code Detail

MEDICARE: CANDICE D FORTUNATO MD PLLC

MEDICARE: CANDICE D FORTUNATO MD PLLC
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
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician
3208M00000XHospitalist Physician

General Provider Information

NPI Number : 1831521228
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANDICE D FORTUNATO MD PLLC
Provider Business Mailing Address
First Line : 500 N RAINBOW BLVD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1061
Country : US
Telephone Number : 702-450-1717
Fax Number : 702-941-6740
Provider Business Practice Location Address
First Line : 500 N RAINBOW BLVD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1061
Country : US
Telephone Number : 702-450-1717
Fax Number : 702-941-6740
Authorized Official
Title or Position : MANAGING MEMBER
Name : CANDICE D FORTUNATO
Credential : MD
Telephone Number : 702-450-1717
Provider Enumeration Date : 08/07/2013
Last Update Date : 08/07/2013

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