Individual
MRS. LUZ M. FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4802 10TH AVE, BROOKLYN, NY 11219-2916
(718) 283-7243
Mailing address
10218 92ND AVE, RICHMOND HILL, NY 11418-2905
(718) 849-3244
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007235
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007235
NEW YORK STATE LICENSE
NY
Enumeration date
06/09/2007
Last updated
07/08/2007
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