Individual
MR. ANTONIO MARCO ONTIVEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
UNIVERISTY OF CALIFORNIA RIVERSIDE, ATHLETICS DEPT, RIVERSIDE, CA 92521-0001
(951) 827-3813
Mailing address
29513 LUXOR RD, MENIFEE, CA 92584-8604
(951) 827-3813
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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