Provider Demographics
NPI:1851033906
Name:CARMONA, ANTONIO JR (CSTFA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:CARMONA
Suffix:JR
Gender:M
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-1810
Mailing Address - Country:US
Mailing Address - Phone:806-206-6161
Mailing Address - Fax:
Practice Address - Street 1:3114 ORANGE ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-1810
Practice Address - Country:US
Practice Address - Phone:806-206-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190498246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant