Provider Demographics
NPI:1235741729
Name:ALCANTARA, PAOLO ANDONI SILLADOR
Entity Type:Individual
Prefix:
First Name:PAOLO ANDONI
Middle Name:SILLADOR
Last Name:ALCANTARA
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 1:3762 R ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2280
Mailing Address - Country:US
Mailing Address - Phone:714-855-6556
Mailing Address - Fax:
Practice Address - Street 1:1158 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4523
Practice Address - Country:US
Practice Address - Phone:209-383-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist