1639174816 NPI number — DR. ALON ANTEBI DO

Table of content: DR. ALON ANTEBI DO (NPI 1639174816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639174816 NPI number — DR. ALON ANTEBI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTEBI
Provider First Name:
ALON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639174816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42135 10TH ST W
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-7095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-726-5005
Provider Business Mailing Address Fax Number:
661-726-5377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42135 10TH ST W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-7095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-726-5005
Provider Business Practice Location Address Fax Number:
661-726-5377
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0801X , with the licence number:  OS8890 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X , with the licence number: 20A8954 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W20A8954A . This is a "MEDICARE PROV #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 061742929 . This is a "BC OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 269326700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00260096 . This is a "RR MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020A89540 . This is a "BS OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: I15007 . This is a "UPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX89540 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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