Provider Demographics
NPI:1568513620
Name:FONSECA, JEANNETTE (PNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CREST RD
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2832
Mailing Address - Country:US
Mailing Address - Phone:760-725-9458
Mailing Address - Fax:760-725-1267
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:BUILDING H 100, SANTA MARGARITA ROAD
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-9151
Practice Address - Country:US
Practice Address - Phone:760-725-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN4872363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics