MEDICARE: KRISTINA FONTANA M. A.

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
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1073591103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA FONTANA M. A.

Provider Business Mailing Address
First Line	:	2040 W CHARLESTON BLVD
Second Line	:	202-A
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2227
Country	:	US
Telephone Number	:	702-671-2355
Fax Number	:	702-382-5388

Provider Business Practice Location Address
First Line	:	2040 W CHARLESTON BLVD
Second Line	:	401
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2227
Country	:	US
Telephone Number	:	702-671-2200
Fax Number	:	702-385-7719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/09/2007

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