Provider Demographics
NPI:1346827698
Name:CANTU, MARLENE J
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:J
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 1:4392 VERMILLION SKY DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7374
Mailing Address - Country:US
Mailing Address - Phone:386-473-3076
Mailing Address - Fax:
Practice Address - Street 1:4392 VERMILLION SKY DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7374
Practice Address - Country:US
Practice Address - Phone:386-473-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program