Provider Demographics
NPI:1225222128
Name:FONSECA, CHRISTINA DARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DARIA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DARLA
Other - Last Name:MUMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:320 LENNON LANE KAISER PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:DEPARTMENT OF DERMATOLOGY
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-817-5600
Mailing Address - Fax:916-442-5702
Practice Address - Street 1:320 LENNON LANE KAISER PERMANENTE MEDICAL GROUP
Practice Address - Street 2:DEPARTMENT OF DERMATOLOGY
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-617-5600
Practice Address - Fax:916-442-5702
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101459207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology