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General NPI Number Information
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NPI Number | 1154335859
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Entity Type | Individual
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Provider Name | RITA MARIANO ANTOLIN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14712 PARTHENIA ST STE E
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2992
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Country | US
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Telephone | 818-830-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 17346 CHATSWORTH ST APT 210
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5714
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Country | US
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Telephone | 818-368-2215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49052
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License Number State | CA
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