Healthcare Provider Details

I. General information

NPI: 1346150398
Provider Name (Legal Business Name): VIOLETA M PANTALEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 5250
FARMINGTON NM
87499-5250
US

IV. Provider business mailing address

PO BOX 5250
FARMINGTON NM
87499-5250
US

V. Phone/Fax

Practice location:
  • Phone: 212-729-7378
  • Fax:
Mailing address:
  • Phone: 212-729-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63410
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: