Healthcare Provider Details

I. General information

NPI: 1760510150
Provider Name (Legal Business Name): ANTONIA CIOVICA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 BARTON RD STE E
REDLANDS CA
92373-1489
US

IV. Provider business mailing address

1686 BARTON RD STE E
REDLANDS CA
92373-1489
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-9551
  • Fax:
Mailing address:
  • Phone: 909-558-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: