Individual provider Active NPI

Vincent Paul Fonseca, MD

  • General Practice Physician
  • San Antonio, TX
National Provider Identifier
1558793596
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
M7972 Issued in TX
Practice address
4025 E Southcross Blvd Ste 15
San Antonio, TX 78222-3641
Phone
(210) 610-7283
Fax
(210) 812-5938
NPI assigned
Aug 1, 2013
Last updated
Jul 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine Physician 2083P0901X M7972 TX
General Practice Physician 208D00000X M7972 TX Primary
Clinical Informatics Physician 2083C0008X M7972 TX
Obesity Medicine (Preventive Medicine) Physician 2083B0002X M7972 TX

Addresses

Primary practice location

4025 E Southcross Blvd Ste 15
San Antonio, TX 78222-3641

Mailing address

402 Donaldson Ave
San Antonio, TX 78201-4907
Phone (210) 279-8911

Other practice location 1

405 W Magnolia Ave
San Antonio, TX 78212-3219
Phone (210) 279-8911

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M7972TXMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Antonio Vascular and Endovascular Clinic PLLC CurrentSince Jul 25, 2019 Accepting new patients

Locations

4025 E Southcross Blvd
Ste 15
San Antonio, TX 78222
Phone (832) 439-7889

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1558793596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 DONALDSON AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782014907",
            "telephone_number": "210-279-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 E SOUTHCROSS BLVD STE 15",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782223641",
            "telephone_number": "210-610-7283",
            "fax_number": "210-812-5938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 W Magnolia Ave",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782123219",
            "country_code": "US",
            "telephone_number": "210-279-8911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "VINCENT",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "TX",
            "license": "M7972",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "M7972",
            "primary": true
        },
        {
            "code": "2083C0008X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Clinical Informatics",
            "state": "TX",
            "license": "M7972",
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "TX",
            "license": "M7972",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.

Verify at the official NPI Registry.