Provider Demographics
NPI:1427602390
Name:FONSECA, ESTHER MARIE (RD LND)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:MARIE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:RD LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AVE LA SIERRA APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4331
Mailing Address - Country:US
Mailing Address - Phone:787-640-6601
Mailing Address - Fax:
Practice Address - Street 1:300 AVE LA SIERRA
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-640-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR865412133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered