MEDICARE: MR. ANTHONY PETRONE JR. MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1023085883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY PETRONE JR. MA

Provider Business Mailing Address
First Line	:	1301 LONG VIEW DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1664
Country	:	US
Telephone Number	:	619-553-8719
Fax Number	:	619-553-7758

Provider Business Practice Location Address
First Line	:	140 SYLVESTER RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-3521
Country	:	US
Telephone Number	:	619-553-8719
Fax Number	:	619-553-7758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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