Provider Demographics
NPI:1063482016
Name:CANTU, LEZA MICHELLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEZA
Middle Name:MICHELLE
Last Name:CANTU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:LEZA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:198 HALPINE RD
Mailing Address - Street 2:APT 1305
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1661
Mailing Address - Country:US
Mailing Address - Phone:301-919-9011
Mailing Address - Fax:301-295-0734
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-4189
Practice Address - Fax:301-295-0734
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered