Juan Carlo Koontz

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-WNVUHS Issued in CA

Practice address

2085 Rustin Ave Unit 2
Riverside, CA 92507-2498

Phone

(951) 955-2501

NPI assigned

Mar 29, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Juan Carlo Pantoja Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1134823487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E ALESSANDRO BLVD UNIT 44",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086170",
            "telephone_number": "951-419-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 RUSTIN AVE UNIT 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072498",
            "telephone_number": "951-955-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "JUAN",
        "middle_name": "CARLO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-WNVUHS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUAN",
            "last_name": "PANTOJA",
            "middle_name": "CARLO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vincent Kong, DO
• David Anthony Konzem, PA-C
• Chulhwe Koo, M.D.
• Joanna Koo, DDS
• John Daniel Koontz, MD
• Analira Koopman
• Truazul P Korazonazul
• Vivekanand Korde, CIP
• Marcella Natasha Kordus-Salonen, PH.D.
• Doris R Kore, DDS

• Peer Specialist in Riverside, CA
• Providers in Riverside, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.