Provider Demographics
NPI:1255779443
Name:FONTE, TIFFANY THERESE (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:THERESE
Last Name:FONTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4275 BURNHAM AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5400
Mailing Address - Country:US
Mailing Address - Phone:702-912-1714
Mailing Address - Fax:702-734-2650
Practice Address - Street 1:108 E LAKE MEAD PKWY STE 302
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-912-1714
Practice Address - Fax:702-734-2650
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPG177527207RC0000X
NVSL0957207R00000X
NVDO2567207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine