Healthcare Provider Details

I. General information

NPI: 1689250136
Provider Name (Legal Business Name): MR. FLORENTINO TANTOY LEANILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 CORDONE AVE
RENO NV
89502-2603
US

IV. Provider business mailing address

975 CORDONE AVE
RENO NV
89502-2603
US

V. Phone/Fax

Practice location:
  • Phone: 775-800-1228
  • Fax: 775-800-1228
Mailing address:
  • Phone: 775-800-1228
  • Fax: 775-800-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: