Provider Demographics
NPI:1801938691
Name:FONSECA, ROBERT JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:FONSECA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W MAIN AVE STE 11A
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4553
Mailing Address - Country:US
Mailing Address - Phone:408-779-7900
Mailing Address - Fax:408-779-8356
Practice Address - Street 1:60 W MAIN AVE STE 11A
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4553
Practice Address - Country:US
Practice Address - Phone:408-779-7900
Practice Address - Fax:408-779-8356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0241280Medicare ID - Type UnspecifiedPERF PROV