Provider Demographics
NPI:1558493221
Name:FONSECA, NINOSKA ROSARIO (MFT)
Entity Type:Individual
Prefix:
First Name:NINOSKA
Middle Name:ROSARIO
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 MARWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065
Mailing Address - Country:US
Mailing Address - Phone:323-478-8372
Mailing Address - Fax:323-478-8372
Practice Address - Street 1:10600 SEPULVEDA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1950
Practice Address - Country:US
Practice Address - Phone:321-821-7959
Practice Address - Fax:323-478-8372
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist