1225222128 NPI number — MRS. CHRISTINA DARIA FONSECA M.D.

Table of content: MRS. CHRISTINA DARIA FONSECA M.D. (NPI 1225222128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225222128 NPI number — MRS. CHRISTINA DARIA FONSECA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONSECA
Provider First Name:
CHRISTINA
Provider Middle Name:
DARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUMM
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
DARLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225222128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 LENNON LANE KAISER PERMANENTE MEDICAL GROUP
Provider Second Line Business Mailing Address:
DEPARTMENT OF DERMATOLOGY
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-817-5600
Provider Business Mailing Address Fax Number:
916-442-5702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 LENNON LANE KAISER PERMANENTE MEDICAL GROUP
Provider Second Line Business Practice Location Address:
DEPARTMENT OF DERMATOLOGY
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-617-5600
Provider Business Practice Location Address Fax Number:
916-442-5702
Provider Enumeration Date:
09/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A101459 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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