GUILLERMO A. FONSECA M.D., PA
Marriage and Family Therapists at 26 St, Miami, FL

License number
Florida ME0064061
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: DR. GUILLERMO ANTONIO FONSECA M.D
Title: PRESIDENT
Phone: (305) 223-3989
Address
Address
14750 SW 26Th St SUITE 212-214, Miami, FL 33185
National Provider ID: 1447796339
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GUILLERMO A. FONSECA M.D., PA

Miami, FL

Status:
Inactive
Industry:
Medical Doctor, Family Doctor
Doing business as:
Guillermo A Fonseca MD<br>Guillermo Fonseca MD
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Sep 17, 1993
Inactive since:
Sep 26, 2014
Phone:
(305) 223-3989 (Phone)
Addresses:
13780 SW 26 St SUITE 105, Miami, FL 33175 (Physical)
11880 SW 40 St, Miami, FL 33175
State ID:
P93000064968
Business type:
Florida Profit Corporation
Office Managers:
Raquel Fonseca (Office Manager),Raquel Bacon (Medical Assistant),Guillermo A Fonseca Director, Owner, Family Practitioner, Medical Doctor, inactive, 13780 SW 26 SUITE 105, Miami, FL 33175 (Physical),...
Agent:
Chaponick, Evelyn,7925 NW 12 St, Miami, FL 33126 (Physical)
EIN:
65-0436567

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