Healthcare Provider Details

I. General information

NPI: 1457860074
Provider Name (Legal Business Name): DANICA-ELLA M PANTOJA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 VISTA SORRENTO PKWY STE 280
SAN DIEGO CA
92121-3776
US

IV. Provider business mailing address

2950 BUSKIRK AVE STE 300
WALNUT CREEK CA
94597-6900
US

V. Phone/Fax

Practice location:
  • Phone: 888-380-0988
  • Fax: 289-236-3022
Mailing address:
  • Phone: 888-380-0988
  • Fax: 289-236-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC002184
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number00024175615
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016725
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001219626
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1017188
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: