Healthcare Provider Details

I. General information

NPI: 1013825561
Provider Name (Legal Business Name): REGINA FRIDELLA COUSINEAU RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA FRIDELLA COUSINEAU RDN

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W AVENIDA CORDOBA
SAN CLEMENTE CA
92672-5412
US

IV. Provider business mailing address

211 W AVENIDA CORDOBA
SAN CLEMENTE CA
92672-5412
US

V. Phone/Fax

Practice location:
  • Phone: 949-842-9975
  • Fax:
Mailing address:
  • Phone: 949-842-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86105081
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86105081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: