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General NPI Number Information
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NPI Number | 1063809051
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Entity Type | Individual
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Provider Name | RAQUEL FONSECA MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 26010 OAK RIDGE DR STE 100
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City | SPRING
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State | TX
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Zip | 77380-1972
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Country | US
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Telephone | 281-245-0288
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Fax | 281-245-0336
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Provider Business Mailing Address
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Address Line | PO BOX 797171
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City | DALLAS
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State | TX
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Zip | 75379-7171
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Country | US
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Telephone | 214-494-4424
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Fax | 214-494-4423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 1014300
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License Number State | MA
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