Provider Demographics
NPI:1598155475
Name:PANTOJAS-LAZA, EMILY (PSY D)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PANTOJAS-LAZA
Suffix:
Gender:F
Credentials:PSY D
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 5094
Mailing Address - Street 2:CARR 630 KM 0.6 BO MARICAO
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5094
Mailing Address - Country:US
Mailing Address - Phone:787-634-3658
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 81.1
Practice Address - Street 2:CALLE SAN DANIEL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-815-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2581103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical