Provider Demographics
NPI:1366485088
Name:FONSECA, ROSA MARGARITA (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:MARGARITA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6783
Mailing Address - Street 2:SANTA ROSA UNIT
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5783
Mailing Address - Country:US
Mailing Address - Phone:787-474-6946
Mailing Address - Fax:
Practice Address - Street 1:CARR # 2 KM 15.5
Practice Address - Street 2:
Practice Address - City:HATO TEJAS BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-474-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7250098OtherHUMANA
PR56664OtherTRIPLE SSS
PR937508OtherEYEMED