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1558864983
ANTONIO FONSECA
VENICE, CA
NPI
1558864983
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2018-03-12
Last Update Date
2018-03-12
Business Address
ANTONIO FONSECA
204 HAMPTON DR
VENICE, CA 90291-2623
Phone number: 310-309-6001
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Mailing Address
ANTONIO FONSECA
204 HAMPTON DR
VENICE, CA 90291-2623
Phone number: 310-309-6001
Copy
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