Provider Demographics
NPI:1487662458
Name:AFIA, ANTHONY FRANCIS
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:AFIA
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 1:11650 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1923
Mailing Address - Country:US
Mailing Address - Phone:909-548-0086
Mailing Address - Fax:909-548-0215
Practice Address - Street 1:11650 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1923
Practice Address - Country:US
Practice Address - Phone:909-548-0086
Practice Address - Fax:909-548-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43559332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0871870001Medicare NSC