Provider Demographics
NPI:1255108015
Name:UELIGITONE, FAITOLO ANTHONY JR
Entity type:Individual
Prefix:
First Name:FAITOLO
Middle Name:ANTHONY
Last Name:UELIGITONE
Suffix:JR
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 1:6013 ARBOR CREST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6643
Mailing Address - Country:US
Mailing Address - Phone:702-809-0506
Mailing Address - Fax:
Practice Address - Street 1:314 FOREMASTER LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1008
Practice Address - Country:US
Practice Address - Phone:702-809-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator