Healthcare Provider Details

I. General information

NPI: 1477152270
Provider Name (Legal Business Name): NICOLE FRECHE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S PALISADE DR STE 200
SANTA MARIA CA
93454-8900
US

IV. Provider business mailing address

505 VIA DE LA CRUZ
SANTA MARIA CA
93455-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3900
  • Fax:
Mailing address:
  • Phone: 805-878-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86097103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: