Organization
RICO FONTILLAS INC
Active
Parent organization
RICO FONTILLAS INC
Other names
Ricardo Fontillas MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
RICO FONTILLAS INC
Authorized official
RICO FONTILLAS MD (OWNER)
(702) 454-0201
Entity
Organization
Contact information
Practice address
1090 WIGWAM PARKWAY, #100, HENDERSON, NV 89074
(702) 454-0201
(702) 454-1245
Mailing address
1090 WIGWAM PARKWAY, #100, HENDERSON, NV 89074
(702) 454-0201
(702) 454-1245
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
6501
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019612
—
NV
Enumeration date
05/09/2007
Last updated
11/30/2007
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