Healthcare Provider Details

I. General information

NPI: 1417958315
Provider Name (Legal Business Name): VIRGINIA DUNGO FONTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E ILLINOIS AVE #201
FRESNO CA
93701-2125
US

IV. Provider business mailing address

3812 N 1ST ST
FRESNO CA
93726-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-2496
  • Fax: 559-266-8560
Mailing address:
  • Phone: 559-495-3120
  • Fax: 559-495-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA38009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: