Provider Demographics
NPI:1699840637
Name:ANTONE, RODERICK (RN)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:ANTONE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:ANTONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PUBLIC HEALTH NURSE
Mailing Address - Street 1:16337 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2160 W 190TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-6103
Practice Address - Country:US
Practice Address - Phone:310-224-6943
Practice Address - Fax:310-224-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551855163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health