Provider Demographics
NPI:1760793103
Name:FOURNIER, MONINA ASUNCION (RD)
Entity Type:Individual
Prefix:MS
First Name:MONINA
Middle Name:ASUNCION
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1716
Mailing Address - Country:US
Mailing Address - Phone:714-979-0342
Mailing Address - Fax:
Practice Address - Street 1:962 GOLDENROD DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1716
Practice Address - Country:US
Practice Address - Phone:714-979-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered