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NPI Code Detail

MEDICARE: MRS. BRENDA KAY FONACIER REGISTERED DIETITIAN

MEDICARE: MRS. BRENDA KAY FONACIER REGISTERED DIETITIAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian18152CA

General Provider Information

NPI Number : 1356406706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA KAY FONACIER REGISTERED DIETITIAN
Provider Business Mailing Address
First Line : 1425 S MAIN ST
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-5318
Country : US
Telephone Number : 925-295-4942
Fax Number : 925-295-4941
Provider Business Practice Location Address
First Line : 1425 S MAIN ST
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-5318
Country : US
Telephone Number : 925-295-4942
Fax Number : 925-295-4941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. BRENDA KAY FONACIER REGISTERED DIETITIAN” Practice Location

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