Provider Demographics
NPI:1043338536
Name:TRIAS-FONSECA, CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:TRIAS-FONSECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 S MCDONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1845
Mailing Address - Country:US
Mailing Address - Phone:323-715-7997
Mailing Address - Fax:
Practice Address - Street 1:1055 CORPORATE CENTER DR STE 430
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7668
Practice Address - Country:US
Practice Address - Phone:323-881-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty