Provider Demographics
NPI:1033433727
Name:DA FONSECA, RENATA CARVALHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENATA
Middle Name:CARVALHO
Last Name:DA FONSECA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 WASHINGTON BLVD
Mailing Address - Street 2:#203
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5442
Mailing Address - Country:US
Mailing Address - Phone:310-463-3294
Mailing Address - Fax:
Practice Address - Street 1:536 EAST ARRELLAGA
Practice Address - Street 2:STE 101
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2262
Practice Address - Country:US
Practice Address - Phone:805-687-2400
Practice Address - Fax:877-307-7062
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice