Healthcare Provider Details

I. General information

NPI: 1578467676
Provider Name (Legal Business Name): ANTHONY CARLINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18985 HIGHWAY 94
DULZURA CA
91917-1527
US

IV. Provider business mailing address

589 N JOHNSON AVE UNIT 127
EL CAJON CA
92020-3145
US

V. Phone/Fax

Practice location:
  • Phone: 619-335-2994
  • Fax:
Mailing address:
  • Phone: 858-239-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number370139AN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: