Healthcare Provider Details

I. General information

NPI: 1972027415
Provider Name (Legal Business Name): IVONNE ANTONIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HUGHES WAY
LONG BEACH CA
90810-1865
US

IV. Provider business mailing address

1515 HUGHES WAY
LONG BEACH CA
90810-1865
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-8000
  • Fax:
Mailing address:
  • Phone: 562-997-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: