Provider Demographics
NPI:1912309543
Name:FONSECA, INALVYS (OTR)
Entity Type:Individual
Prefix:
First Name:INALVYS
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25371 SW 121 COURT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3507
Mailing Address - Country:US
Mailing Address - Phone:786-223-1233
Mailing Address - Fax:
Practice Address - Street 1:14221 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7236
Practice Address - Country:US
Practice Address - Phone:305-603-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT19278OtherFLORIDA DEPARTMENT OF HEALTH