Basic Information
| Provider Information | |||||||||
| NPI: | 1831315068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANTIGUE | ||||||||
| FirstName: | ANNA MARIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2742 DOW AVE | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927807242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146651600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16300 SAND CANYON AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926183711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495524200 | ||||||||
| FaxNumber: | 9492622300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 10/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 434826 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.