Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME 104324 | FL |
NPI | 1124213012 |
---|---|
Provider Name | Dr. Rodrigo B Fonseca |
First Address | Pembroke Pines, FL 33024-3611 |
Second Address | Pembroke Pines, FL 33024-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 01/02/2012 |