Provider Demographics
NPI:1760042063
Name:ASSAF, ANTONY
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:ASSAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTONY
Other - Middle Name:
Other - Last Name:TAAMNEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 E ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3147
Mailing Address - Country:US
Mailing Address - Phone:626-332-3145
Mailing Address - Fax:
Practice Address - Street 1:3430 COGSWELL RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2785
Practice Address - Country:US
Practice Address - Phone:626-622-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2022-12-21
Deactivation Date:2022-11-01
Deactivation Code:
Reactivation Date:2022-12-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health