Provider Demographics
NPI:1164593877
Name:PANTOJA, ANA BERTHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:BERTHA
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANA
Other - Middle Name:BERTHA
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3342
Mailing Address - Country:US
Mailing Address - Phone:626-960-6999
Mailing Address - Fax:626-960-5246
Practice Address - Street 1:1300 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3342
Practice Address - Country:US
Practice Address - Phone:626-960-6999
Practice Address - Fax:626-960-5246
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH73348Medicare UPIN