Provider Demographics
NPI:1528826914
Name:SIFONTES TORTOLO, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SIFONTES TORTOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:SIFONTES TORTOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6425 MECHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1231
Mailing Address - Country:US
Mailing Address - Phone:512-587-6209
Mailing Address - Fax:
Practice Address - Street 1:6425 MECHAM AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1231
Practice Address - Country:US
Practice Address - Phone:512-587-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)