Individual provider · NPI-1

Fides D Antonio, NP

Nurse Practitioner · Walnut Creek, CA

NPI number1609462845
StatusActive
Last updated in NPPESDec 11, 2020

Details

NPI
1609462845
Entity type
Individual (NPI-1)
Name
Fides D Antonio
Credential
NP
Sex
Female
Sole proprietor
No
Enumeration date
Dec 11, 2020
Certification date
Dec 11, 2020
Last updated
Dec 11, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363L00000X Nurse Practitioner95015546CAYes

Practice location

130 La Casa Via Ste 108
Walnut Creek, CA 94598-3036

Phone 877-448-3627 · Fax 866-507-1164

Mailing address

901 Mcclintock Dr Ste 202
Burr Ridge, IL 60527-0872

Phone 630-655-6748 · Fax 630-734-4715

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