Provider Demographics
NPI:1023085883
Name:PETRONE, ANTHONY JR (MA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:PETRONE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LONG VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1664
Mailing Address - Country:US
Mailing Address - Phone:619-553-8719
Mailing Address - Fax:619-553-7758
Practice Address - Street 1:140 SYLVESTER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-8719
Practice Address - Fax:619-553-7758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians