Individual
GUSTAVO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
751 MEDICAL CENTER CT, CHULA VISTA, CA 91911-6617
(619) 502-5800
Mailing address
3905 MAIN ST, CHULA VISTA, CA 91911-6213
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95042131
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
95042131
CA
Other
Enumeration date
08/19/2020
Last updated
03/31/2026
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