Healthcare Provider Details

I. General information

NPI: 1396997839
Provider Name (Legal Business Name): DEBORAH HIDEKO ANTONIO B.A., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD SUITE 100
PASADENA CA
91107-6622
US

IV. Provider business mailing address

433 S GRIFFITH PARK DR
BURBANK CA
91506-2716
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 818-845-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: