Individual
LUIS JESUS FONSECA VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 933-6407
Mailing address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 933-6407
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95384669
CA
Other
Enumeration date
09/26/2025
Last updated
09/26/2025
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