Provider Demographics
NPI:1922620103
Name:ANTONIO, ROBERTO CARLO
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLO
Last Name:ANTONIO
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 1:1364 CAMINITO AMERIGO UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-3147
Mailing Address - Country:US
Mailing Address - Phone:623-698-3879
Mailing Address - Fax:619-272-2465
Practice Address - Street 1:1364 CAMINITO AMERIGO UNIT 3
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-3147
Practice Address - Country:US
Practice Address - Phone:623-698-3879
Practice Address - Fax:619-272-2465
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA812764404OtherMEDICAL BILLING