Provider Demographics
NPI:1467882910
Name:ANTONIO, LORIBETTE (FNP)
Entity Type:Individual
Prefix:
First Name:LORIBETTE
Middle Name:
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 W SAN MARCOS BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1244
Mailing Address - Country:US
Mailing Address - Phone:760-736-8810
Mailing Address - Fax:760-736-3157
Practice Address - Street 1:727 W SAN MARCOS BLVD
Practice Address - Street 2:STE 112
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1244
Practice Address - Country:US
Practice Address - Phone:760-736-8810
Practice Address - Fax:760-736-3157
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily