Provider Demographics
NPI:1235644311
Name:CANTU, ANTELIA
Entity Type:Individual
Prefix:
First Name:ANTELIA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1146
Mailing Address - Country:US
Mailing Address - Phone:509-488-5611
Mailing Address - Fax:
Practice Address - Street 1:425 E MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1146
Practice Address - Country:US
Practice Address - Phone:509-488-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator