Healthcare Provider Details

I. General information

NPI: 1558186973
Provider Name (Legal Business Name): ANTHONY ALLAN DITO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 30TH ST
OAKLAND CA
94609-3302
US

IV. Provider business mailing address

3883 20TH ST
SAN FRANCISCO CA
94114-3018
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-9200
  • Fax:
Mailing address:
  • Phone: 415-200-2978
  • Fax: 415-259-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: