Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fides D Antonio, NP

Individual provider Nurse Practitioner · NPI 1609462845

Fides D Antonio, NP is a Nurse Practitioner in Walnut Creek, California. Qualified in 2020, 6 years ago. Practices with Mark H Mazur MD and Barry Statner MD a Professional Corporation, a 15-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2020
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

130 La Casa Via Ste 108
Walnut Creek, CA 94598-3036
Phone: (877) 448-3627
Fax: (866) 507-1164
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 95015546 (CA)

Record details

NPI number1609462845
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedDecember 11, 2020
Last updated in NPPESDecember 11, 2020
Certification dateDecember 11, 2020
Mailing address901 McClintock Dr Ste 202, Burr Ridge, IL 60527-0872

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Mark H Mazur Md And Barry Statner Md A Professional Corporation — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Walnut Creek