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General NPI Number Information
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NPI Number | 1700554664
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Entity Type | Individual
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Provider Name | DANIELA PANTOJA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 1421 GUERNEVILLE RD STE 218
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City | SANTA ROSA
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State | CA
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Zip | 95403-7255
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Country | US
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Telephone | 916-508-2052
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Fax |
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Provider Business Mailing Address
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Address Line | 320 K ST APT 29
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City | DAVIS
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State | CA
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Zip | 95616-4263
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Country | US
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Telephone | 209-561-4151
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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