Individual
MR. MIGUEL FONSECA-MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
42104 N VENTURE DR STE D118, ANTHEM, AZ 85086-3837
(623) 505-9880
Mailing address
80 W MARYLAND AVE APT 207, PHOENIX, AZ 85013-1266
(480) 686-3301
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
10680
AZ
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/08/2023
Last updated
06/17/2025
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