Provider Demographics
NPI:1679062152
Name:GONZALEZ PANTOJA, YAIMARA (FNP)
Entity Type:Individual
Prefix:
First Name:YAIMARA
Middle Name:
Last Name:GONZALEZ PANTOJA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 BELLAIRE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5515
Mailing Address - Country:US
Mailing Address - Phone:832-834-4688
Mailing Address - Fax:832-834-4687
Practice Address - Street 1:5901 BELLAIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5515
Practice Address - Country:US
Practice Address - Phone:832-834-4688
Practice Address - Fax:832-834-4687
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily