Basic Information
| Provider Information | |||||||||
| NPI: | 1295927887 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANTELO | ||||||||
| FirstName: | FERNANDO | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W CARSON ST, BOX #12 | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102222643 | ||||||||
| FaxNumber: | 3102228002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W CARSON ST, BOX #12 | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102222643 | ||||||||
| FaxNumber: | 3102228002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 06/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A108309 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.