Provider Demographics
NPI:1659735033
Name:FONSECA, VERONICA (DO)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6324 N CALLE DE ONA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3419
Mailing Address - Country:US
Mailing Address - Phone:520-256-3358
Mailing Address - Fax:
Practice Address - Street 1:6324 N CALLE DE ONA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3419
Practice Address - Country:US
Practice Address - Phone:520-256-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ592414Medicaid