Provider Demographics
NPI:1033392451
Name:ANTONIO, ELENITA MATUGUINA
Entity Type:Individual
Prefix:MS
First Name:ELENITA
Middle Name:MATUGUINA
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3307
Mailing Address - Country:US
Mailing Address - Phone:831-753-6001
Mailing Address - Fax:831-753-6007
Practice Address - Street 1:517 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3307
Practice Address - Country:US
Practice Address - Phone:831-753-6001
Practice Address - Fax:831-753-6007
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS REG #1826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1826OtherCAS REG # 1826