Healthcare Provider Details

I. General information

NPI: 1497004758
Provider Name (Legal Business Name): MUNEERA FONTAINE CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 09/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 MASSACHUSETTS AVE SE
WASHINGTON DC
20019-2943
US

IV. Provider business mailing address

3725 MASSACHUSETTS AVE SE
WASHINGTON DC
20019-2943
US

V. Phone/Fax

Practice location:
  • Phone: 202-297-2722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: