Provider Demographics
NPI:1013247725
Name:FOUNTAINE, JAMAL DAVID (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:DAVID
Last Name:FOUNTAINE
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BARROWS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2534
Mailing Address - Country:US
Mailing Address - Phone:510-735-7832
Mailing Address - Fax:510-350-8209
Practice Address - Street 1:1421 BARROWS RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2534
Practice Address - Country:US
Practice Address - Phone:510-735-7832
Practice Address - Fax:510-350-8209
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP26912146L00000X
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic