Provider Demographics
NPI:1013168749
Name:JEREMY ANUNTIYO MD INC
Entity Type:Organization
Organization Name:JEREMY ANUNTIYO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUNTIYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-529-7772
Mailing Address - Street 1:1360 W 6TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3599
Mailing Address - Country:US
Mailing Address - Phone:562-529-7772
Mailing Address - Fax:562-529-5449
Practice Address - Street 1:1360 W 6TH ST STE 310
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3599
Practice Address - Country:US
Practice Address - Phone:562-529-7772
Practice Address - Fax:562-529-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty