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General NPI Number Information
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NPI Number | 1457730616
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Entity Type | Organization
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Legal Business Name | VALY FONTIL MEDICAL CORP.
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 156 2ND ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-3724
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Country | US
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Telephone | 734-678-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 156 2ND ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-3724
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Country | US
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Telephone | 734-678-9010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VALY FONTIL
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Credential | M.D.
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Telephone | 734-678-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 117418
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 117418
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License Number State | CA
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