Provider Demographics
NPI:1477864338
Name:FONTENOT, RITA RAE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RITA RAE
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669-0482
Mailing Address - Country:US
Mailing Address - Phone:337-540-0530
Mailing Address - Fax:
Practice Address - Street 1:1403 BEECH ST
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669-4101
Practice Address - Country:US
Practice Address - Phone:337-540-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD 076R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist