Healthcare Provider Details

I. General information

NPI: 1831018498
Provider Name (Legal Business Name): ALEXIS FONSECA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13130 BURBANK BLVD
SHERMAN OAKS CA
91401-6000
US

IV. Provider business mailing address

13130 BURBANK BLVD
SHERMAN OAKS CA
91401-6000
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-0360
  • Fax:
Mailing address:
  • Phone: 818-781-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: