Provider Demographics
NPI:1467159236
Name:CANTARTZOGLOU, YANNI ANTONIOS
Entity Type:Individual
Prefix:
First Name:YANNI
Middle Name:ANTONIOS
Last Name:CANTARTZOGLOU
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 1:23256 TORONJA CORTE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9365
Mailing Address - Country:US
Mailing Address - Phone:951-561-0031
Mailing Address - Fax:
Practice Address - Street 1:23256 TORONJA CORTE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-9365
Practice Address - Country:US
Practice Address - Phone:951-561-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty