| Doctor Name: | DR. VINCENT PAUL FONSECA |
| NPI Number: | 1558793596 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | M7972 |
| Business Practice Address: | 405 W Magnolia Ave San Antonio, TX - 782123219 |
| Business Phone Number: | 2102798911 |
| Business Fax Number: | |
| Mailing Address: | 405 W Magnolia Ave, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782123219 |
| Phone Number: | 2102798911 |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2013 |
| NPI Last Update Date: | 12/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | M7972 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |