Individual
DR. ANDREW M ANTILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
(214) 771-6210
Mailing address
3700 ROSS AVE APT 123, DALLAS, TX 75204-5429
(214) 771-6210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T7854
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/19/2019
Last updated
06/13/2022
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