Healthcare Provider Details

I. General information

NPI: 1346480183
Provider Name (Legal Business Name): ANTIQUITES ET MEDECINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E 21ST ST
SAN BERNARDINO CA
92404-4815
US

IV. Provider business mailing address

11420 ETON LN STE. A
RIVERSIDE CA
92507-6619
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-2266
  • Fax:
Mailing address:
  • Phone: 951-204-3759
  • Fax: 951-787-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberNMTCB 004954
License Number StateCA

VIII. Authorized Official

Name: MRS. PAMELA LOSCUTOFF
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 951-204-3759