Provider Demographics
NPI:1629702105
Name:FENTON, VICTORIA LOUISE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOUISE
Last Name:FENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 CANOPY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1412
Mailing Address - Country:US
Mailing Address - Phone:323-522-5663
Mailing Address - Fax:
Practice Address - Street 1:1412 CANOPY CREEK WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1412
Practice Address - Country:US
Practice Address - Phone:323-522-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No374J00000XNursing Service Related ProvidersDoula