Provider Demographics
NPI:1407046824
Name:CAMMARATA, ANTONINO SIMONE (DO)
Entity type:Individual
Prefix:DR
First Name:ANTONINO
Middle Name:SIMONE
Last Name:CAMMARATA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20333 N 19TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-9901
Mailing Address - Country:US
Mailing Address - Phone:480-707-9504
Mailing Address - Fax:602-581-7764
Practice Address - Street 1:20333 N 19TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-9901
Practice Address - Country:US
Practice Address - Phone:480-707-9504
Practice Address - Fax:602-581-7764
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08495000208600000X
PAOS014837208600000X
AZ005651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery