Healthcare Provider Details

I. General information

NPI: 1740618420
Provider Name (Legal Business Name): ANTONETTE MALIWAT ANTONIO N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS STREET, SUITE 128
SAN DIEGO CA
92110
US

IV. Provider business mailing address

5054 LAMBERT LANE
SAN DIEGO CA
92115
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8890
  • Fax:
Mailing address:
  • Phone: 619-829-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: