Provider Demographics
NPI:1114393667
Name:PANTOJA, JESUS JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:PANTOJA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 KENGARD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2437
Mailing Address - Country:US
Mailing Address - Phone:323-633-3971
Mailing Address - Fax:
Practice Address - Street 1:11627 TELEGRAPH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3693
Practice Address - Country:US
Practice Address - Phone:562-948-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant