Provider Demographics
NPI:1073829685
Name:PANTAZOPOULOS, CHRISTINA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:PANTAZOPOULOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 STRANDBERG ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4759
Mailing Address - Country:US
Mailing Address - Phone:917-364-7839
Mailing Address - Fax:
Practice Address - Street 1:31546 RAILROAD CANYON RD STE B
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9434
Practice Address - Country:US
Practice Address - Phone:951-394-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11260207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery