Provider Demographics
NPI:1457860074
Name:PANTOJA, DANICA-ELLA M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANICA-ELLA
Middle Name:M
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-6900
Mailing Address - Country:US
Mailing Address - Phone:888-380-0988
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:10251 VISTA SORRENTO PKWY STE 280
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3776
Practice Address - Country:US
Practice Address - Phone:888-380-0988
Practice Address - Fax:289-236-3022
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001219626163W00000X
MDAC002184363L00000X
DCRN1017188163W00000X
VA00024175615363L00000X
CA95016725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2017011092Medicaid