Provider Demographics
NPI:1437164100
Name:FONTELONGA, ANTONIO HERLANDER
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:HERLANDER
Last Name:FONTELONGA
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 1:75 PRINGLE WAY STE 706
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1472
Mailing Address - Country:US
Mailing Address - Phone:775-784-5975
Mailing Address - Fax:775-784-3722
Practice Address - Street 1:75 PRINGLE WAY STE 706
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1472
Practice Address - Country:US
Practice Address - Phone:775-784-5975
Practice Address - Fax:775-784-3722
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV100667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38278Medicare PIN