MEDICARE: DR. ANTONIO HERLANDER FONTELONGA

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	207RH0003X	Hematology & Oncology Physician	100667	NV

General Provider Information

NPI Number	:	1437164100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO HERLANDER FONTELONGA

Provider Business Mailing Address
First Line	:	75 PRINGLE WAY STE 706
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1472
Country	:	US
Telephone Number	:	775-784-5975
Fax Number	:	775-784-3722

Provider Business Practice Location Address
First Line	:	75 PRINGLE WAY STE 706
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1472
Country	:	US
Telephone Number	:	775-784-5975
Fax Number	:	775-784-3722

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/06/2014

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