Provider Demographics
NPI:1033708227
Name:CANTU, CRISTOBAL JR
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:CANTU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 SHARK BAY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1961
Mailing Address - Country:US
Mailing Address - Phone:956-764-9359
Mailing Address - Fax:
Practice Address - Street 1:210 W DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2205
Practice Address - Country:US
Practice Address - Phone:956-712-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119727183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician