Active NPI
Maria Camila Borrero Fonseca, D.D.S
- Pediatric Dentistry
- Tracy, CA
National Provider Identifier
1033245345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 51046
- Practice address
- 569 W Lowell Ave Ste 200
Tracy, CA 95376-3084 - Phone
- (310) 498-8167
- Fax
- (209) 832-5885
- NPI assigned
- Feb 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 51046 | CA | Primary |
Addresses
Primary practice location
569 W Lowell Ave Ste 200
Tracy, CA 95376-3084
Mailing address
569 W Lowell Ave Ste 200
Tracy, CA 95376-3084
Phone (310) 498-8167
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51046 | Other | CA | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51046 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1033245345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "569 W LOWELL AVE STE 200",
"city": "TRACY",
"state": "CA",
"postal_code": "953763084",
"telephone_number": "310-498-8167",
"fax_number": "209-832-5885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "569 W LOWELL AVE STE 200",
"city": "TRACY",
"state": "CA",
"postal_code": "953763084",
"telephone_number": "310-498-8167",
"fax_number": "209-832-5885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORRERO FONSECA",
"first_name": "MARIA",
"middle_name": "CAMILA",
"name_prefix": "Miss",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "51046",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "51046",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.