Organization
FONSECA PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMON AUGUSTO FONSECA MD (OWNER)
(407) 729-6068
Entity
Organization
Contact information
Practice address
2801 17TH ST UNIT 102, SAINT CLOUD, FL 34769-4939
(407) 519-2930
(407) 556-3565
Mailing address
2801 17TH ST UNIT 102, SAINT CLOUD, FL 34769-4939
(407) 519-2930
(407) 556-3565
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120425200
—
FL
01
—
V95A6
BLUE CROSS BLUE SHIELD NUMBER
FL
Enumeration date
10/09/2023
Last updated
04/11/2024
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