Healthcare Provider Details

I. General information

NPI: 1356256945
Provider Name (Legal Business Name): MARCELLA CRISTINA SAD FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7827 CONVOY CT STE 406
SAN DIEGO CA
92111-1218
US

IV. Provider business mailing address

7827 CONVOY CT STE 406
SAN DIEGO CA
92111-1218
US

V. Phone/Fax

Practice location:
  • Phone: 619-719-1649
  • Fax: 619-719-5463
Mailing address:
  • Phone: 619-719-1649
  • Fax: 619-719-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: