Healthcare Provider Details

I. General information

NPI: 1124403282
Provider Name (Legal Business Name): ELIZABETH FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 ALMOND ST
DOS PALOS CA
93620-2303
US

IV. Provider business mailing address

PO BOX 2087
MERCED CA
95344-0087
US

V. Phone/Fax

Practice location:
  • Phone: 209-392-0280
  • Fax:
Mailing address:
  • Phone: 209-381-6800
  • Fax: 209-725-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF95905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF95905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: