Healthcare Provider Details

I. General information

NPI: 1023085883
Provider Name (Legal Business Name): ANTHONY PETRONE JR. MA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SYLVESTER RD
SAN DIEGO CA
92106-3521
US

IV. Provider business mailing address

1301 LONG VIEW DR
CHULA VISTA CA
91915-1664
US

V. Phone/Fax

Practice location:
  • Phone: 619-553-8719
  • Fax: 619-553-7758
Mailing address:
  • Phone: 619-553-8719
  • Fax: 619-553-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: