Mario J Fonseca, MD, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

65287 Issued in FL

Legal business name

MARIO J FONSECA, MD, PA

Practice address

7325 SW 63Rd Ave
Suite 201
South Miami, FL 33143-4811

Phone

(305) 669-9404

Fax

(305) 669-9660

NPI assigned

Apr 13, 2011

Organization subpart

No

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

Authorized official

Name

Mario J Fonseca, M.D.NPI 1124082003

Title

President

Phone

(305) 669-9404

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mario J Fonseca, M.D.

  • Family Medicine Physician
  • South Miami, FL
  • NPI 1124082003
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1811287667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7325 SW 63RD AVE",
            "address_2": "SUITE 201",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331434811",
            "telephone_number": "305-669-9404",
            "fax_number": "305-669-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7325 SW 63RD AVE",
            "address_2": "SUITE 201",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331434811",
            "telephone_number": "305-669-9404",
            "fax_number": "305-669-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO J FONSECA, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "FONSECA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-669-9404",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "65287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374540600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos Miguel Marill, M.D., P.A.
• Maday Marin Mees, APRN
• Niram Alfredo Marin
• Octavio Daniel Marin
• Adriana Maria Marino, MS, CCC-SLP
• Mark E. Baum, D.C.
• Deirdre Markey, HAS, BC-HIS
• Atara Marko, PA-C
• John V Marraccini, M.D.
• Amanda Marie Marrero

• Family Medicine Physician in South Miami, FL
• Providers in South Miami, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.