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General NPI Number Information
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NPI Number | 1477864338
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Entity Type | Individual
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Provider Name | RITA RAE FONTENOT D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 1403 BEECH ST
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City | WESTLAKE
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State | LA
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Zip | 70669-4101
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Country | US
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Telephone | 337-540-0530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 482
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City | WESTLAKE
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State | LA
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Zip | 70669-0482
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Country | US
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Telephone | 337-540-0530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PD 076R
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License Number State | LA
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