Provider Demographics
NPI:1992338248
Name:PANTUA, ANTONIO R (CAREGIVER)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:R
Last Name:PANTUA
Suffix:
Gender:M
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 1/2 E LIME AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5158
Mailing Address - Country:US
Mailing Address - Phone:626-422-5842
Mailing Address - Fax:
Practice Address - Street 1:1766 E CALAVERAS ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3310
Practice Address - Country:US
Practice Address - Phone:626-422-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant