Provider Demographics
NPI:1396134946
Name:PANTOJA, PATRICIA (LND)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF VISTAS DEL RIO
Mailing Address - Street 2:EDIF. # 4 APART. 25 B
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8841
Mailing Address - Country:US
Mailing Address - Phone:787-408-0546
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 164 SECTOR EL DESVIO
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0515
Practice Address - Country:US
Practice Address - Phone:787-869-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1887133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist