Provider Demographics
NPI:1972261279
Name:PANTOJA, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
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:PO BOX 390511
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32739-0511
Mailing Address - Country:US
Mailing Address - Phone:407-955-7898
Mailing Address - Fax:
Practice Address - Street 1:3154 LYNNHAVEN ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-4225
Practice Address - Country:US
Practice Address - Phone:407-955-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No171W00000XOther Service ProvidersContractor