Basic Information
| Provider Information | |||||||||
| NPI: | 1427207414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FONSECA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | IVONNE | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11201 BENTON ST | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923571000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28125 BRADLEY RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925862248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096721931 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2008 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCS15500 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.