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General NPI Number Information
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NPI Number | 1184005258
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Entity Type | Individual
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Provider Name | ROBERT FONTANILLA PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1970 UNIVERSITY AVE
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City | RIVERSIDE
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State | CA
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Zip | 92507-5202
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Country | US
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Telephone | 833-867-4642
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Fax | 360-462-5825
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Provider Business Mailing Address
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Address Line | 1970 UNIVERSITY AVE
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City | RIVERSIDE
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State | CA
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Zip | 92507-5202
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Country | US
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Telephone | 833-867-4642
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Fax | 360-462-5825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA52552
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License Number State | CA
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