Provider Demographics
NPI:1306328323
Name:MARIANO-SABIDO, ANTOINETTE (PA-C)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:MARIANO-SABIDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 BALFOUR RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4970
Mailing Address - Country:US
Mailing Address - Phone:925-240-9116
Mailing Address - Fax:
Practice Address - Street 1:2221 BALFOUR RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4970
Practice Address - Country:US
Practice Address - Phone:252-409-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9229363A00000X
GA9229363A00000X
IA093289363AM0700X
CA59419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical