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NPI Code Detail

MEDICARE: FRANKLIN FONTILLAS

MEDICARE:   FRANKLIN  FONTILLAS
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
1372600000XAdult Companion

General Provider Information

NPI Number : 1083343560
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRANKLIN FONTILLAS
Provider Business Mailing Address
First Line : 5525 ROSE THICKET ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-1653
Country : US
Telephone Number : 702-882-7736
Fax Number : 702-633-8928
Provider Business Practice Location Address
First Line : 5525 ROSE THICKET ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-1653
Country : US
Telephone Number : 702-882-7736
Fax Number : 702-633-8928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2022
Last Update Date : 06/09/2022

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Directions to “ FRANKLIN FONTILLAS ” Practice Location

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