MEDICARE: LAURA FONSECA MD

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
1	207VX0000X	Obstetrics Physician	S1398	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1861879447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FONSECA MD

Provider Business Mailing Address
First Line	:	4217 NORTH MCCOLL RD STE 700
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4466
Country	:	US
Telephone Number	:	956-627-0817
Fax Number	:	956-627-0975

Provider Business Practice Location Address
First Line	:	4217 NORTH MCCOLL RD STE 700
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4466
Country	:	US
Telephone Number	:	956-627-0817
Fax Number	:	956-627-0975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2015
Last Update Date	:	05/14/2020

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