Provider Demographics
NPI:1518987882
Name:ONTIVEROS, ANTONIO MARCO (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MARCO
Last Name:ONTIVEROS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29513 LUXOR RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8604
Mailing Address - Country:US
Mailing Address - Phone:951-827-3813
Mailing Address - Fax:
Practice Address - Street 1:UNIVERISTY OF CALIFORNIA RIVERSIDE
Practice Address - Street 2:ATHLETICS DEPT
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-0001
Practice Address - Country:US
Practice Address - Phone:951-827-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer