1598635054 NPI number — ROBERTO RAMON FONSECA PEREZ

Table of content: ROBERTO RAMON FONSECA PEREZ (NPI 1598635054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598635054 NPI number — ROBERTO RAMON FONSECA PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONSECA PEREZ
Provider First Name:
ROBERTO
Provider Middle Name:
RAMON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598635054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2653 SE 21ST CT UNIT 107D
Provider Second Line Business Mailing Address:
2653 SE 21ST CT UNIT 107D
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33035-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-305-2023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15924 SW 92ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-964-5824
Provider Business Practice Location Address Fax Number:
786-452-1200
Provider Enumeration Date:
11/10/2025

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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