Healthcare Provider Details

I. General information

NPI: 1013830439
Provider Name (Legal Business Name): ALEXANDRA FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11925 SW 72ND ST
MIAMI FL
33183-2709
US

IV. Provider business mailing address

5850 SW 149TH AVE
MIAMI FL
33193-2480
US

V. Phone/Fax

Practice location:
  • Phone: 305-374-3569
  • Fax:
Mailing address:
  • Phone: 305-504-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-2835121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: