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NPI Code Detail

MEDICARE: NINOTSCHKA FONSECA

MEDICARE: NINOTSCHKA FONSECA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1023299567
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINOTSCHKA FONSECA
Provider Business Mailing Address
First Line : 1508 S 4TH ST
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-3321
Country : US
Telephone Number : 626-281-8933
Fax Number :
Provider Business Practice Location Address
First Line : 4928 LANKERSHIM BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91601-4443
Country : US
Telephone Number : 818-763-7919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2007
Last Update Date : 11/26/2007

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Directions to “ NINOTSCHKA FONSECA ” Practice Location

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