Provider Demographics
NPI:1174839104
Name:PANTOJA, CARLOS JOSUE (MS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSUE
Last Name:PANTOJA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4375
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4375
Mailing Address - Country:US
Mailing Address - Phone:787-858-4845
Mailing Address - Fax:787-858-4845
Practice Address - Street 1:CARR. 2 KM 40.5
Practice Address - Street 2:PLAZA JARDINES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-4845
Practice Address - Fax:787-858-4845
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist