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General NPI Number Information
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NPI Number | 1568000743
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Entity Type | Individual
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Provider Name | MARIA ANGELICA FONSECA RICAURTE DDS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 2999 REGENT ST STE 714
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City | BERKELEY
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State | CA
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Zip | 94705-2122
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Country | US
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Telephone | 510-848-3143
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 CASA VERDE ST APT 2504
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City | SAN JOSE
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State | CA
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Zip | 95134-3338
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Country | US
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Telephone | 310-905-0335
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DDS104383
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License Number State | CA
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