Provider Demographics
NPI:1578971511
Name:PANTOJA, EMMANUEL (FNP)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:PANTOJA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NYSSA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2352
Mailing Address - Country:US
Mailing Address - Phone:956-605-0193
Mailing Address - Fax:956-585-8008
Practice Address - Street 1:1000 E EXPRESSWAY 83 UNIT 4
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-8302
Practice Address - Country:US
Practice Address - Phone:956-585-1688
Practice Address - Fax:956-585-8008
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily