Robert Fontanilla, PA-C
Individual provider Active NPI Physician Assistant · Riverside, CA
NPI 1184005258 · NPPES record last updated Dec 11, 2024
Key facts
- NPI
- 1184005258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA52552 (CA)
- Practice address
- 1970 University Ave
Riverside, CA 92507-5202 - Phone
- (833) 867-4642
- Fax
- (360) 462-5825
- NPI assigned
- Jun 15, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dap Health Inc
Practice addresses (Care Compare)
68555 Ramon Rd
Cathedral City, CA 92234-3310
Phone (760) 507-3310
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160304001518 | CA | Practitioner - Physician Assistant | 1557667318 | Reassigns benefits to 3 organizations |
| I20221027002535 | IL | Practitioner - Physician Assistant | 1557667318 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52552 | CA | MD | Marriage & Family Therapist |
| PA52552 | CA | MD | Physician Assistant |
Practice roles (3 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neighborhood Healthcare | Current |
Accepting new patients | |
| Dap Health, Inc. | Current |
Accepting new patients | |
| Neighborhood Healthcare | Current |
Accepting new patients |
Locations
58581 US Highway 371
Ste Fgh
Anza, CA 92539
Phone (951) 763-4759
68555 Ramon Rd
Cathedral City, CA 92234
Phone (619) 873-3538
69175 Ramon Rd
#A
Cathedral Cty, CA 92234
Phone (760) 321-6776
855 E Madison Ave
El Cajon, CA 92020
Phone (619) 440-2751
425 N Date St
Escondido, CA 92025
Phone (760) 737-2035
460 N Elm St
Escondido, CA 92025
Phone (760) 520-8100
215 S Hickory St
Escondido, CA 92025
Phone (619) 354-3833
425 N Date St
#0
Escondido, CA 92025
1970 University Ave
Riverside, CA 92507
Phone (951) 213-3450
41840 Enterprise Cir N
Temecula, CA 92590
Phone (951) 225-6400
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- rfontanilla704894@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA52552 | CA | Yes |
Addresses
Primary practice location
1970 University Ave
Riverside, CA 92507-5202
Mailing address
1970 University Ave
Riverside, CA 92507-5202
Phone (833) 867-4642
Other providers in Riverside, CA
- James Fong
- Voy K Fong
- Emelda Makochi Fonki
- Cristian Fonseca
- Marie Therese Fonseca
- Cliff Fontelera
- Emily Foote
- Allyson Ford
- Carla Ford
- Cedrina Ford
All providers in Riverside, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.