Individual
WALSTIR H FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
76 S KINGS PEAK DR, LINDON, UT 84042-2223
(801) 370-5193
Mailing address
76 S KINGS PEAK DR, LINDON, UT 84042-2223
(801) 370-5193
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
329175-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-00322
UNITED HEALTHCARE
UT
01
—
107007883101
IHC
UT
01
—
110166693
PALMETTO
UT
01
—
286636
DMBA
UT
01
—
46639
PEHP
UT
01
—
870281028FO1
EMIA
UT
01
—
QM0000000074
ALTIUS
UT
Enumeration date
07/15/2006
Last updated
11/23/2021
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