Provider Demographics
NPI:1023144748
Name:FONTANEZ, MARIA MIGDALIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MIGDALIA
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4138
Mailing Address - Country:US
Mailing Address - Phone:337-824-8868
Mailing Address - Fax:337-824-8829
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4138
Practice Address - Country:US
Practice Address - Phone:337-824-8868
Practice Address - Fax:337-824-8829
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA08550R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1908711Medicaid
LA1908711Medicaid