Individual
FIDES D ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
130 LA CASA VIA STE 108, WALNUT CREEK, CA 94598-3036
(877) 448-3627
(866) 507-1164
Mailing address
901 MCCLINTOCK DR STE 202, BURR RIDGE, IL 60527-0872
(630) 655-6748
(630) 734-4715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95015546
CA
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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