| Mario J Fonseca, Md, Pa | |
|
7325 Sw 63rd Ave Suite 201 South Miami FL 33143-4811 | |
| (305) 669-9404 | |
| (305) 669-9660 |
| Full Name | Mario J Fonseca, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 7325 Sw 63rd Ave, South Miami, Florida |
| Authorized Official Name and Position | Mario J Fonseca (PRESIDENT) |
| Authorized Official Contact | 3056699404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mario J Fonseca, Md, Pa 7325 Sw 63rd Ave Suite 201 South Miami FL 33143-4811 Ph: (305) 669-9404 | Mario J Fonseca, Md, Pa 7325 Sw 63rd Ave Suite 201 South Miami FL 33143-4811 Ph: (305) 669-9404 |
| NPI Number | 1811287667 |
|---|---|
| Provider Enumeration Date | 04/13/2011 |
| Last Update Date | 04/13/2011 |
| Medicare PECOS PAC ID | 6406753805 |
|---|---|
| Medicare Enrollment ID | O20110628000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811287667 | NPI | - | NPPES |
| 374540600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 65287 (Florida) | Primary |
| Provider Name | Mario Fonseca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124082003 PECOS PAC ID: 9931006327 Enrollment ID: I20031215000488 |
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