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
1	372600000X	Adult 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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