Healthcare Provider Details

I. General information

NPI: 1164755757
Provider Name (Legal Business Name): PABLO ANTINAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 S MOONEY BLVD SUITE B
VISALIA CA
93277-9535
US

IV. Provider business mailing address

6500 S MOONEY BLVD SUITE B
VISALIA CA
93277-9535
US

V. Phone/Fax

Practice location:
  • Phone: 559-685-1200
  • Fax: 559-685-9742
Mailing address:
  • Phone: 559-685-1200
  • Fax: 559-685-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: