Fontanilla, Larry L

Fontanilla, Larry L is an individual health care provider with primary practice located at 413 Lilly Rd Ne , Olympia WA 98506-5133. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Fontanilla, Larry L can be contacted via phone (360) 491-9480.

Contact Information

Primary practice address
413 Lilly Rd Ne Olympia WA 98506-5133
Phone: (360) 491-9480
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD00043682 Washington
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD00043682 Washington

Profile Details

NPI number 1518908797
LBN Legal business name Fontanilla, Larry L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Nov 27th, 2007 - about 17 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 1518908797 NPPES
Other 191058 WA L & I
Other 2537FO WA L & I
MEDICAID 8396830 WA L & I
Other 8939281 WA L & I
Other H39247 WA L & I
Other P00234764 WA L & I

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