Provider Demographics
NPI:1174985121
Name:PANTOJA, JOE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:LUIS
Last Name:PANTOJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27200 IRIS AVE # MOB2
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4803
Mailing Address - Country:US
Mailing Address - Phone:951-897-5671
Mailing Address - Fax:
Practice Address - Street 1:27200 IRIS AVE # MOB2
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4803
Practice Address - Country:US
Practice Address - Phone:951-897-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1529452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery