Individual
MR. TED R FONTANILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
47-403 AHUIMANU RD, KANEOHE, HI 96744-4850
(808) 239-9947
(808) 239-2213
Mailing address
47-403 AHUIMANU RD, KANEOHE, HI 96744-4850
(808) 239-9947
(808) 239-2213
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11453
HI
Other
Enumeration date
10/16/2009
Last updated
03/17/2018
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