Provider Demographics
NPI:1851592729
Name:FONSECA, BERTHA CARIDAD (MD)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:CARIDAD
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1167
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 411
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2049
Practice Address - Country:US
Practice Address - Phone:305-444-4175
Practice Address - Fax:305-444-4176
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1014272084N0400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL5987Medicare PIN