Healthcare Provider Details

I. General information

NPI: 1720919749
Provider Name (Legal Business Name): LAUREN ELIZABETH FONSECA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD FL 2
WARWICK RI
02886-4330
US

IV. Provider business mailing address

56 SOPHIA CT
WAKEFIELD RI
02879-2548
US

V. Phone/Fax

Practice location:
  • Phone: 401-736-3731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00573
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: