Doctor Name: | DR. AUDBERTO CESAR ANTONINI |
NPI Number: | 1235486192 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 29013R |
Business Practice Address: | 5315 James Mcmanus St Santa Maria Ponce, PR - 00730 |
Business Phone Number: | 5172140889 |
Business Fax Number: | |
Mailing Address: | 309 Calle Pedro Bigay, Baldrich, Hato Rey SAN JUAN |
State: | PR |
Postal Code: | 009184024 |
Phone Number: | 5172140889 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2012 |
NPI Last Update Date: | 08/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29013R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |