Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01037992 | IN |
NPI | 1114076080 |
---|---|
Provider Name | Dr. Angelita Fontanilla |
First Address | Watseka, IL 60970-1644 |
Second Address | Watseka, IL 60970-7568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 21/03/2013 |