Provider Demographics
NPI:1619101490
Name:FORTUNATO, CANDICE DEGUZMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:DEGUZMAN
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-439-3309
Mailing Address - Fax:702-947-6740
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:STE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-439-3309
Practice Address - Fax:702-947-6740
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14750207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics