Provider Demographics
NPI:1972810539
Name:FONSECA, ANACANI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANACANI
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E REDD RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7265
Mailing Address - Country:US
Mailing Address - Phone:915-270-8057
Mailing Address - Fax:888-268-4808
Practice Address - Street 1:840 E REDD RD BLDG 3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7265
Practice Address - Country:US
Practice Address - Phone:915-270-8057
Practice Address - Fax:888-268-4808
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR38412080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty