Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003224767 |
---|---|
Provider Name | Leonela Fonseca |
First Address | Miami, FL 33186 |
Second Address | Miami, FL 33186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2014 |
Last Update Date | 25/07/2014 |