Individual
FRED FOMBRUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2380 W HORIZON RIDGE PKWY STE 110, HENDERSON, NV 89052-5078
(972) 656-0493
Mailing address
205 WINNSBORO ST, HENDERSON, NV 89074-7877
(862) 755-9418
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1527
NV
Other
Enumeration date
05/12/2014
Last updated
05/12/2014
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