Andrew Lazaro Fonticiella, PA STUDENT

NPI #1023814001 in San Lorenzo, California

Provider Information

NPI Number: 1023814001
Entity Type: Individual
Name: Andrew Lazaro Fonticiella, PA STUDENT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Student in an Organized Health Care Education/Training Program
Credential: PA STUDENT
Enumeration Date: Feb 20, 2025
Last Updated: Feb 20, 2025

Practice Location

Address: 16037 VIA DEL SOL
City: San Lorenzo
State: California
ZIP Code: 94580-2407
Phone: (818) 935-7076

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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