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General NPI Number Information
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NPI Number | 1922620103
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Entity Type | Individual
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Provider Name | ROBERTO CARLO ANTONIO
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Gender | Male
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1364 CAMINITO AMERIGO UNIT 3
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City | CHULA VISTA
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State | CA
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Zip | 91915-3147
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Country | US
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Telephone | 623-698-3879
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Fax | 619-272-2465
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Provider Business Mailing Address
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Address Line | 1364 CAMINITO AMERIGO UNIT 3
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City | CHULA VISTA
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State | CA
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Zip | 91915-3147
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Country | US
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Telephone | 623-698-3879
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Fax | 619-272-2465
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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 | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number |
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License Number State |
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