Provider Demographics
NPI:1811646060
Name:DORTA LAFONTAINE, DANIELLA
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:DORTA LAFONTAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140877
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0877
Mailing Address - Country:US
Mailing Address - Phone:787-420-3504
Mailing Address - Fax:
Practice Address - Street 1:CARR. 653 KM 3.2 URB. CAMPO REAL
Practice Address - Street 2:BO. BARRANCA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-420-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program