Provider Demographics
NPI:1891097325
Name:FONTENETTE, CANDACE ELAINE (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ELAINE
Last Name:FONTENETTE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 FULLBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3934
Mailing Address - Country:US
Mailing Address - Phone:818-720-7408
Mailing Address - Fax:
Practice Address - Street 1:10015 FULLBRIGHT AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3934
Practice Address - Country:US
Practice Address - Phone:818-720-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic