Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 32565 | AZ |
NPI | 1275517898 |
---|---|
Provider Name | Dr. Rafael Fonseca |
First Address | Scottsdale, AZ 85259-5404 |
Second Address | Scottsdale, AZ 85259-5404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84751 | (02) |