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Individual

MR. MANUEL FONSECA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSN, FNP-C

Contact information

Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-7000
Mailing address
11737 ANHINGA DR, WELLINGTON, FL 33414-5807
(352) 215-1501

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11001507
FL

Other

Enumeration date
06/30/2019
Last updated
11/27/2023
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