Provider Demographics
NPI:1841519980
Name:FONSECA, HUGO BITTAR (DO)
Entity type:Individual
Prefix:DR
First Name:HUGO
Middle Name:BITTAR
Last Name:FONSECA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1720
Mailing Address - Country:US
Mailing Address - Phone:954-620-0011
Mailing Address - Fax:954-620-0238
Practice Address - Street 1:160 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1720
Practice Address - Country:US
Practice Address - Phone:954-620-0011
Practice Address - Fax:954-620-0238
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS10973207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10973OtherFLORIDA PHYSICIAN STATE LICENSE
FL009578300Medicaid
FLGX576ZMedicare PIN