Mr Miguel Fonseca-moreno, is a medicare enrolled "Physician Assistant" physician in Anthem, Arizona. His current practice location is
42104 N Venture Dr Ste D118, Anthem, Arizona. You can reach out to his office (for appointments etc.) via phone at
(623) 505-9880.
Mr Miguel Fonseca-moreno is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417724402.
Physician's Profile
Full Name | Mr Miguel Fonseca-moreno |
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Gender | Male |
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Speciality | Physician Assistant |
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Location | 42104 N Venture Dr Ste D118, Anthem, Arizona |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417724402
- Provider Enumeration Date: 12/08/2023
- Last Update Date: 06/17/2025
Medicare PECOS Information:
- PECOS PAC ID: 9739611179
- Enrollment ID: I20241010001304
Medical Identifiers
Medical identifiers for Mr Miguel Fonseca-moreno such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1417724402 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207R00000X | Internal Medicine | 10680 (Arizona) | Secondary |
363A00000X | Physician Assistant | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Miguel Fonseca-moreno is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Miguel Fonseca-moreno, 80 W Maryland Ave Apt 207, Phoenix, AZ 85013-1266 Ph: (480) 686-3301 | Mr Miguel Fonseca-moreno, 42104 N Venture Dr Ste D118, Anthem, AZ 85086-3837 Ph: (623) 505-9880 |
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