Individual
MAIRA FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
234 E 149TH ST, BRONX, NY 10451-5504
(212) 639-3210
Mailing address
1275 YORK AVE # 8, NEW YORK, NY 10065-6007
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
300446
NY
Other
Enumeration date
03/31/2015
Last updated
11/14/2024
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