Healthcare Provider Details

I. General information

NPI: 1447435938
Provider Name (Legal Business Name): TATIANA ANTOCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WAMPANOAG TRL UNIT 102
RIVERSIDE RI
02915-1507
US

IV. Provider business mailing address

803 E LINCOLN AVE
SUNNYSIDE WA
98944-2383
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-3325
  • Fax: 401-435-3327
Mailing address:
  • Phone: 509-643-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60315224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: