Provider Demographics
NPI:1003168659
Name:ANTES, CAROLYN (RDCS (AE, PE))
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ANTES
Suffix:
Gender:F
Credentials:RDCS (AE, PE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 S TROYTON LN
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-1601
Mailing Address - Country:US
Mailing Address - Phone:310-487-1646
Mailing Address - Fax:310-693-9726
Practice Address - Street 1:21311 S TROYTON LN
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-1601
Practice Address - Country:US
Practice Address - Phone:310-487-1646
Practice Address - Fax:310-693-9726
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-06
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139536246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography