Provider Demographics
NPI:1437303310
Name:ANTIS, DANIEL JAMES ZAMORA (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES ZAMORA
Last Name:ANTIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2407
Mailing Address - Country:US
Mailing Address - Phone:562-310-1374
Mailing Address - Fax:
Practice Address - Street 1:450 ARMSTRONG DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2407
Practice Address - Country:US
Practice Address - Phone:562-310-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20037OtherSTATE LICENSE NUMBER