Provider Demographics
NPI:1558727446
Name:PANTOJA, GRISEL AMAIVE
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:AMAIVE
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PALM AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4458
Mailing Address - Country:US
Mailing Address - Phone:786-317-1856
Mailing Address - Fax:
Practice Address - Street 1:3800 PALM AVE APT 216
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4458
Practice Address - Country:US
Practice Address - Phone:786-317-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist