Provider Demographics
NPI:1770874703
Name:LAFONTAINE, DIANA CHAVEZ (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CHAVEZ
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-8743
Mailing Address - Fax:562-933-8744
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-8743
Practice Address - Fax:562-933-8744
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA124100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics