=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821932575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXYS KATHERINE FONSECA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 FOGG RD
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02190-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-789-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 MORNINGSIDE AVE
-----------------------------------------------------
City | ACUSHNET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02743-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-789-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------