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Fontaine Willis
NPI 1184215550 · on the registry since 2021 · sole proprietor
Practice
- Address
- 4420 N Varsity Ave Apt 1040
San Bernardino, CA 92407 - Phone
- (213) 949-6845
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- Driver
172A00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-01-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California