Provider Demographics
NPI:1285177311
Name:CORREIA, ANTONIO F
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:F
Last Name:CORREIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 CRESTVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:925-628-7539
Mailing Address - Fax:888-505-8818
Practice Address - Street 1:2800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9720
Practice Address - Country:US
Practice Address - Phone:209-628-5738
Practice Address - Fax:888-505-8818
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)