Fontanilla, Jose Mario D Cuyegkeng

Fontanilla, Jose Mario D Cuyegkeng is an individual health care provider with primary practice located at 401 Bicentennial Way , Santa Rosa CA 95403-2149. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Fontanilla, Jose Mario D Cuyegkeng can be contacted via phone (707) 393-4704.

Contact Information

Primary practice address
401 Bicentennial Way Santa Rosa CA 95403-2149
Phone: (707) 393-4704
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 23108 West Virginia

Profile Details

NPI number 1164528469
LBN Legal business name Fontanilla, Jose Mario D Cuyegkeng
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated Dec 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164528469 NPPES
West Virginia MEDICAID 3810013316

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