Provider Demographics
NPI:1992005300
Name:ANTIMO, NORBERTO (RAS)
Entity Type:Individual
Prefix:MR
First Name:NORBERTO
Middle Name:
Last Name:ANTIMO
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S SAN PEDRO ST STE G4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1938
Mailing Address - Country:US
Mailing Address - Phone:213-620-5712
Mailing Address - Fax:213-621-4155
Practice Address - Street 1:420 S SAN PEDRO ST STE G4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1938
Practice Address - Country:US
Practice Address - Phone:213-620-5712
Practice Address - Fax:213-621-4155
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)