Individual provider · NPI-1
Destinee Antillon, Program Administrato
Rehabilitation Practitioner · Riverside, CA
NPI number1801027651
StatusActive
Last updated in NPPESMar 31, 2025
Details
- NPI
- 1801027651
- Entity type
- Individual (NPI-1)
- Name
- Destinee Antillon
- Credential
- Program Administrato
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 28, 2009
- Certification date
- Mar 31, 2025
- Last updated
- Mar 31, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225400000X | Rehabilitation Practitioner | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – |
Practice location
3625 14th StRiverside, CA 92501-3815
Phone 951-955-1540
Mailing address
3625 14th StRiverside, CA 92501-3815
Phone 951-955-1540
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