Individual
GUILLERMO ROBERTO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
5600 SAINT MORITZ ST, BELLAIRE, TX 77401-2617
(832) 646-8021
Mailing address
5600 SAINT MORITZ ST, BELLAIRE, TX 77401-2617
(832) 646-8021
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
SA00378
TX
246ZS0410X
Surgical Technologist
SA00378
TX
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
02/18/2008
Last updated
11/15/2021
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