Healthcare Provider Details

I. General information

NPI: 1013247725
Provider Name (Legal Business Name): JAMAL DAVID FOUNTAINE PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BARROWS RD
OAKLAND CA
94610-2534
US

IV. Provider business mailing address

1421 BARROWS RD
OAKLAND CA
94610-2534
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-7832
  • Fax: 510-350-8209
Mailing address:
  • Phone: 510-735-7832
  • Fax: 510-350-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP26912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: