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General NPI Number Information
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NPI Number | 1376565408
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Entity Type | Individual
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Provider Name | JOSE FONSECA M.S., A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | DUKE UNIVERSITY 118 CAMERON INDOOR STADIUM
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City | DURHAM
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State | NC
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Zip | 27708-0001
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Country | US
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Telephone | 919-613-7559
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Fax | 919-681-7866
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Provider Business Mailing Address
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Address Line | 221 MORNING VIEW CT
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City | DURHAM
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State | NC
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Zip | 27703-2934
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Country | US
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Telephone | 919-596-5221
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1010
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License Number State | NC
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