Healthcare Provider Details

I. General information

NPI: 1437096609
Provider Name (Legal Business Name): MISS LA'SHAY ANTIONETTE FOUNTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HARVEY DR APT 234
WALNUT CREEK CA
94597-3603
US

IV. Provider business mailing address

1001 HARVEY DR
WALNUT CREEK CA
94597-3609
US

V. Phone/Fax

Practice location:
  • Phone: 510-300-7552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: