Provider Demographics
NPI:1124345186
Name:FONTAINE, FRIEDA PAULINE (PHD, NDTR)
Entity type:Individual
Prefix:DR
First Name:FRIEDA
Middle Name:PAULINE
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:PHD, NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N KENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1314
Mailing Address - Country:US
Mailing Address - Phone:310-476-2821
Mailing Address - Fax:
Practice Address - Street 1:1040 N KENTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1314
Practice Address - Country:US
Practice Address - Phone:310-709-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 133N00000X
CA86027888136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered