Provider Demographics
NPI:1194310276
Name:FONSECA, DENISIS M
Entity type:Individual
Prefix:
First Name:DENISIS
Middle Name:M
Last Name:FONSECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21520 SW 97TH PL
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3718
Mailing Address - Country:US
Mailing Address - Phone:786-554-8920
Mailing Address - Fax:786-661-4862
Practice Address - Street 1:12966 SW 89TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5850
Practice Address - Country:US
Practice Address - Phone:786-554-8920
Practice Address - Fax:786-661-4862
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist