Provider Demographics
NPI:1891419784
Name:FONG, REGINA (RDN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N MAIN ST UNIT 413
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3436
Mailing Address - Country:US
Mailing Address - Phone:510-461-1712
Mailing Address - Fax:
Practice Address - Street 1:418 N MAIN ST UNIT 413
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-3436
Practice Address - Country:US
Practice Address - Phone:510-461-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered