Most Relevant Information
Provider Data
| NPI Number: | 1003201799 |
| Provider Name: | MAIRA FONSECA |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/31/2015 |
| Last Updated: | 07/07/2015 |
Provider Practice Location
1275 YORK AVE # 8
NEW YORK
NY
100656007
Practice Location Phone/Fax
| Phone: | 2126393210 |
| Fax: |
Provider Mailing Location
1275 YORK AVE # 8
NEW YORK
NY
100656007
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |