Provider Demographics
NPI:1700078490
Name:FONSECA, RAMON AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:AUGUSTO
Last Name:FONSECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 17TH ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4939
Mailing Address - Country:US
Mailing Address - Phone:407-519-2930
Mailing Address - Fax:407-556-3565
Practice Address - Street 1:2801 17TH ST UNIT 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4939
Practice Address - Country:US
Practice Address - Phone:407-519-2930
Practice Address - Fax:407-556-3565
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002996100Medicaid