Benjamin Fonseca
Specialist/Technologist, Athletic Trainer in Charlotte, NC. Individual provider (NPI-1).
NPI number1124459862
StatusActive
Last updated in NPPESDec 5, 2013
Details
- NPI
- 1124459862
- Entity type
- Individual (NPI-1)
- Name
- Benjamin Fonseca
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 5, 2013
- Last updated
- Dec 5, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 1814 | NC | Yes |
Practice location
10318 Glenburn LnCharlotte, NC 28278-6005
Phone 704-906-8095
Mailing address
10318 Glenburn LnCharlotte, NC 28278-6005
Phone 704-906-8095
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