Healthcare Provider Details

I. General information

NPI: 1144299074
Provider Name (Legal Business Name): CARLOS A. PANTOJAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 AVE PONCE DE LEON SUITE 306
SAN JUAN PR
00909-1900
US

IV. Provider business mailing address

PO BOX 361670
SAN JUAN PR
00936-1670
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-0440
  • Fax: 787-999-0442
Mailing address:
  • Phone: 787-999-0440
  • Fax: 787-999-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number9017
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: