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General NPI Number Information
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NPI Number | 1841012150
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Entity Type | Organization
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Legal Business Name | STEFANI FONTANA LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 14018 AESTHETIC CIRCLE
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City | HOUSTON
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State | TX
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Zip | 77062
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Country | US
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Telephone | 281-940-1535
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 W 23RD ST
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City | HOUSTON
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State | TX
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Zip | 77008
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Country | US
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Telephone | 913-333-8763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEFANI FONTANA
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Credential | MD
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Telephone | 913-333-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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