Provider Demographics
NPI:1003287285
Name:PANTOJA, DARLING TAIZ
Entity Type:Individual
Prefix:
First Name:DARLING
Middle Name:TAIZ
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 CALLE CACATUA
Mailing Address - Street 2:URB LOS MONTES
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9431
Mailing Address - Country:US
Mailing Address - Phone:787-306-1900
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 18.4
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-306-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-120291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15-120OtherCNC, CERTIFICADO DE NECESIDAD Y CONVENIENCIA