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General NPI Number Information
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NPI Number | 1881475762
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Entity Type | Organization
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Legal Business Name | FONSECA PEDIATRICS LLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 2801 17TH ST UNIT 102
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4939
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Country | US
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Telephone | 407-519-2930
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Fax | 407-556-3565
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Provider Business Mailing Address
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Address Line | 2801 17TH ST UNIT 102
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4939
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Country | US
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Telephone | 407-519-2930
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Fax | 407-556-3565
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Authorized Official
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Title or Position | OWNER
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Name | RAMON AUGUSTO FONSECA
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Credential | MD
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Telephone | 407-729-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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