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NPI Code Detail

MEDICARE: VINCENT M FORTANASCE MD, INC

MEDICARE: VINCENT M FORTANASCE MD, INC
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
12084N0400XNeurology PhysicianA25976CA

General Provider Information

NPI Number : 1568567055
Entity Type Code : Organization
Provider Name (Legal Business Name) : VINCENT M FORTANASCE MD, INC
Provider Business Mailing Address
First Line : 289 W HUNTINGTON DR STE 309
Second Line :
City : ARCADIA
State : CA
Zip : 91007-3493
Country : US
Telephone Number : 626-445-8481
Fax Number : 626-574-9669
Provider Business Practice Location Address
First Line : 289 W HUNTINGTON DR STE 309
Second Line :
City : ARCADIA
State : CA
Zip : 91007-3493
Country : US
Telephone Number : 626-445-8481
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : TIFFANY N. SAM
Credential :
Telephone Number : 626-445-8481
Provider Enumeration Date : 09/13/2006
Last Update Date : 06/12/2020

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Directions to “VINCENT M FORTANASCE MD, INC ” Practice Location

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