NPI 1184215550

Fontaine Willis

Practitioner Driver San Bernardino, CA

Practice location

Address: 4420 N Varsity Ave APT 1040, San Bernardino, CA 92407-4636
Phone: (213) 949-6845

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence Y7940726 (CA)

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Registry record

NPI: 1184215550
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jan 2021
Record last updated: 28 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.