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General NPI Number Information
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NPI Number | 1396134946
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Entity Type | Individual
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Provider Name | PATRICIA PANTOJA LND
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | CARRETERA 164 SECTOR EL DESVIO
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City | NARANJITO
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State | PR
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Zip | 00719-0515
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Country | US
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Telephone | 787-869-1290
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Fax |
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Provider Business Mailing Address
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Address Line | EDIF VISTAS DEL RIO EDIF. # 4 APART. 25 B
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City | BAYAMON
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State | PR
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Zip | 00959-8841
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Country | US
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Telephone | 787-408-0546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 1887
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License Number State | PR
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