Provider Demographics
NPI:1770183683
Name:FONSECA, ANA CECILIA (CPC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CECILIA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 SW 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3456
Mailing Address - Country:US
Mailing Address - Phone:305-671-3330
Mailing Address - Fax:
Practice Address - Street 1:3456 SW 112TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3456
Practice Address - Country:US
Practice Address - Phone:305-671-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor