Provider Demographics
NPI:1114230232
Name:FONTECHA, ERNEST
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:FONTECHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-660-6400
Mailing Address - Fax:813-660-6699
Practice Address - Street 1:3140 S FALKENBURG RD STE 302
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2594
Practice Address - Country:US
Practice Address - Phone:813-660-6400
Practice Address - Fax:813-660-6699
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139358207R00000X
IL125057972207R00000X
NJ25MA10668500207R00000X
FLME166594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine