Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G72697 | CA |
NPI | 1013913755 |
---|---|
Provider Name | James Donald Fontaine |
First Address | San Diego, CA 92130-6657 |
Second Address | San Diego, CA 92130-6657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 22/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84091 | (02) |