Healthcare Provider Details

I. General information

NPI: 1215438346
Provider Name (Legal Business Name): AARON ADAM FONSECA-PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date: 10/01/2026
Reactivation Date: 10/07/2026

III. Provider practice location address

7800 ARROYO CIR STE B
GILROY CA
95020-7346
US

IV. Provider business mailing address

1004 FITZGERALD ST
SALINAS CA
93906-4640
US

V. Phone/Fax

Practice location:
  • Phone: 877-910-6538
  • Fax:
Mailing address:
  • Phone: 831-206-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: