Provider Demographics
NPI:1669879847
Name:DE LA FUENTE, DELMA (RD)
Entity type:Individual
Prefix:
First Name:DELMA
Middle Name:
Last Name:DE LA FUENTE
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 1:90 SPRING LAKE PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1646
Mailing Address - Country:US
Mailing Address - Phone:404-229-9659
Mailing Address - Fax:404-352-4456
Practice Address - Street 1:90 SPRING LAKE PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1646
Practice Address - Country:US
Practice Address - Phone:404-229-9659
Practice Address - Fax:404-352-4456
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered