Provider Demographics
NPI:1063809051
Name:FONSECA, RAQUEL (MD)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 797171
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-7171
Mailing Address - Country:US
Mailing Address - Phone:214-494-4424
Mailing Address - Fax:214-494-4423
Practice Address - Street 1:26010 OAK RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1972
Practice Address - Country:US
Practice Address - Phone:281-245-0288
Practice Address - Fax:281-245-0336
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10143002084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology