Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 700718 | CA |
NPI | 1003436528 |
---|---|
Provider Name | Christian Karl Antonio |
First Address | San Francisco, CA 94143-2204 |
Second Address | San Francisco, CA 94143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2020 |
Last Update Date | 24/04/2020 |