Provider Demographics
NPI:1568346559
Name:FONSA, BETRAND F
Entity type:Individual
Prefix:
First Name:BETRAND
Middle Name:F
Last Name:FONSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 NW 151ST TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8985
Mailing Address - Country:US
Mailing Address - Phone:405-315-2115
Mailing Address - Fax:
Practice Address - Street 1:8915 S OLIE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9317
Practice Address - Country:US
Practice Address - Phone:405-768-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator