MEDICARE: JOSE L. PANTOJA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	C43031	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C43031	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1891721353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE L. PANTOJA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 666
Second Line	:
City	:	ARTESIA
State	:	CA
Zip	:	90702-0666
Country	:	US
Telephone Number	:	562-634-4939
Fax Number	:	562-634-5809

Provider Business Practice Location Address
First Line	:	5750 DOWNEY AVE
Second Line	:	SUITE 202
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1405
Country	:	US
Telephone Number	:	562-634-4939
Fax Number	:	562-634-5809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	11/13/2007

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