Provider Demographics
NPI:1225009491
Name:CANTU, MARICELA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1996
Mailing Address - Country:US
Mailing Address - Phone:713-941-7721
Mailing Address - Fax:713-946-1950
Practice Address - Street 1:3919 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1996
Practice Address - Country:US
Practice Address - Phone:713-941-7721
Practice Address - Fax:713-946-1950
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8637207V00000X, 174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8637OtherSTATE LICENSE #
265915YMOPMedicare PIN
TXI44028Medicare UPIN
TX8G0923Medicare ID - Type Unspecified
TX177309501Medicaid