Provider Demographics
NPI:1861879447
Name:FONSECA, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 NORTH MCCOLL RD STE 700
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4466
Mailing Address - Country:US
Mailing Address - Phone:956-627-0817
Mailing Address - Fax:956-627-0975
Practice Address - Street 1:4217 NORTH MCCOLL RD STE 700
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4466
Practice Address - Country:US
Practice Address - Phone:956-627-0817
Practice Address - Fax:956-627-0975
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1398207VX0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program