Provider Demographics
NPI:1386938074
Name:PANTOJA, ELOISA
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:PANTOJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 NW 5TH TER # 1402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3885
Mailing Address - Country:US
Mailing Address - Phone:786-584-7225
Mailing Address - Fax:
Practice Address - Street 1:8565 NW 5TH TER # 1402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3885
Practice Address - Country:US
Practice Address - Phone:786-584-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-29021103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty