MEDICARE: CRISTINA DEPANTE ANTONIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	53061	CA

General Provider Information

NPI Number	:	1689958258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA DEPANTE ANTONIO

Provider Business Mailing Address
First Line	:	111 W WASHINGTON AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-2629
Country	:	US
Telephone Number	:	760-291-0299
Fax Number	:	760-291-0212

Provider Business Practice Location Address
First Line	:	111 W WASHINGTON AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-2629
Country	:	US
Telephone Number	:	760-291-0299
Fax Number	:	760-291-0212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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Directions to “ CRISTINA DEPANTE ANTONIO ” Practice Location

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