Individual provider Active NPI

Antonette Maliwat Antonio, N.P

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1740618420
Registry record updated Sep 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
23320 Issued in CA
Practice address
3851 Rosecrans Street, Suite 128
San Diego, CA 92110
Phone
(619) 692-8890
NPI assigned
Oct 16, 2013
Last updated
Sep 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 23320 CA Primary

Addresses

Primary practice location

3851 Rosecrans Street, Suite 128
San Diego, CA 92110

Mailing address

5054 Lambert Lane
San Diego, CA 92115
Phone (619) 829-5497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250218001302 CA Practitioner - Nurse Practitioner 7416477781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Somagen Healthcare IncGroup PAC ID 1557530151, 53 clinicians

Practice addresses (Care Compare)

8590 Rio San Diego Dr
Suite 111
San Diego, CA 92108-5597
Phone (619) 736-4600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Somagen Healthcare Inc CurrentSince Feb 1, 2025 Accepting new patients
Somagen Healthcare Inc CurrentSince Feb 1, 2025 Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients

Locations

750 Otay Lakes Rd
Chula Vista, CA 91910
Phone (619) 259-9462

760 Otay Lakes Rd
Chula Vista, CA 91910
Phone (619) 821-2300

1740 Rosecrans St
San Diego, CA 92106
Phone (619) 790-7800

5671 Balboa Ave
San Diego, CA 92111
Phone (855) 362-9773

8260 Mira Mesa Blvd
Ste A
San Diego, CA 92126
Phone (855) 362-9773

8590 Rio San Diego Dr
Ste 111
San Diego, CA 92108
Phone (619) 736-4600

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789689600000",
    "number": "1740618420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5054 LAMBERT LANE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92115",
            "telephone_number": "619-829-5497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROSECRANS STREET, SUITE 128",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92110",
            "telephone_number": "619-692-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIO",
        "first_name": "ANTONETTE",
        "middle_name": "MALIWAT",
        "credential": "N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-16",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "23320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.