Individual
JONATHAN D FONBUENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1799 MOUNT MARIAH DR, LAS VEGAS, NV 89106-1501
(702) 383-1961
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
13111023-1206
UT
363AM0700X
Medical Physician Assistant
Primary
PA2984
NV
Other
Enumeration date
04/12/2019
Last updated
05/16/2024
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