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Organization
MARIO J FONSECA, MD, PA
Active
Organization
MARIO J FONSECA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO J FONSECA M.D. (PRESIDENT)
(305) 669-9404
Entity
Organization
Contact information
Practice address
7325 SW 63RD AVE, SUITE 201, SOUTH MIAMI, FL 33143-4811
(305) 669-9404
(305) 669-9660
Mailing address
7325 SW 63RD AVE, SUITE 201, SOUTH MIAMI, FL 33143-4811
(305) 669-9404
(305) 669-9660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
65287
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374540600
—
FL
Enumeration date
04/13/2011
Last updated
04/13/2011
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