Provider Demographics
NPI:1942051974
Name:FONSECA A. SERVICES CORP
Entity Type:Organization
Organization Name:FONSECA A. SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:FONSECA ARAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-870-2159
Mailing Address - Street 1:100 NE 15TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4581
Mailing Address - Country:US
Mailing Address - Phone:954-870-2159
Mailing Address - Fax:
Practice Address - Street 1:100 NE 15TH ST STE 209
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4581
Practice Address - Country:US
Practice Address - Phone:954-870-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy