Individual
MR. ISAAC JEREMY ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335-4219
(951) 643-2340
Mailing address
14677 MERRILL AVE, FONTANA, CA 92335-4219
(951) 643-2340
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
258893
CA
Other
Enumeration date
10/22/2025
Last updated
10/22/2025
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