Provider Demographics
NPI:1295927887
Name:ANTELO, FERNANDO (MD)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:ANTELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST, BOX #12
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-2643
Mailing Address - Fax:310-222-8002
Practice Address - Street 1:1000 W CARSON ST, BOX #12
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2643
Practice Address - Fax:310-222-8002
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108309207ZP0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology