Guillermo Roberto Fonseca, LSA
Physician Assistant, Surgical in Bellaire, TX. Individual provider (NPI-1).
NPI number1407024052
StatusActive
Last updated in NPPESNov 15, 2021
Details
- NPI
- 1407024052
- Entity type
- Individual (NPI-1)
- Name
- Guillermo Roberto Fonseca
- Credential
- LSA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 18, 2008
- Certification date
- Nov 15, 2021
- Last updated
- Nov 15, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | – | – | Yes |
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | SA00378 | TX | |
| 246ZS0410X | Specialist/Technologist, Other, Surgical Technologist | SA00378 | TX |
Practice location
5600 Saint Moritz StBellaire, TX 77401-2617
Phone 832-646-8021
Mailing address
5600 Saint Moritz StBellaire, TX 77401-2617
Phone 832-646-8021
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