Basic Information
| Provider Information | |||||||||
| NPI: | 1629340021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONSECA- PINEDA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | LEONILA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6500 BOEING DR STE L150 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799251156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157795600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6621 DONIPHAN DR STE G | ||||||||
| Address2: | |||||||||
| City: | CANUTILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 798355005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158775100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2012 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0146241 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.