Provider Demographics
NPI:1700801511
Name:MAROTTA, ANTONIO B
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:B
Last Name:MAROTTA
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 1:2423 CAMINO DEL RIO S STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3734
Mailing Address - Country:US
Mailing Address - Phone:619-293-3741
Mailing Address - Fax:619-293-3746
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:619-293-3741
Practice Address - Fax:619-293-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32937106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist