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Individual
ROBERT ANTONACCI
Active
Individual
ROBERT ANTONACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY32573
CA
103TC0700X
Clinical Psychologist
PSY32573
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
11/21/2014
Last updated
07/01/2023
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