Healthcare Provider Details

I. General information

NPI: 1962745554
Provider Name (Legal Business Name): CYNTHIA MARIE ANTONIO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

725 W LA VETA AVE STE 220
ORANGE CA
92868-4446
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7002
  • Fax:
Mailing address:
  • Phone: 714-771-5700
  • Fax: 714-771-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP22233
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: