Provider Demographics
NPI:1841012150
Name:STEFANI FONTANA LLC
Entity type:Organization
Organization Name:STEFANI FONTANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-333-8763
Mailing Address - Street 1:1323 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008
Mailing Address - Country:US
Mailing Address - Phone:913-333-8763
Mailing Address - Fax:
Practice Address - Street 1:14018 AESTHETIC CIRCLE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:281-940-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty