Provider Demographics
NPI:1376001776
Name:CANTU, RUBEN JR
Entity Type:Individual
Prefix:
First Name:RUBEN
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 1:713 SW C AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4311
Mailing Address - Country:US
Mailing Address - Phone:580-262-8945
Mailing Address - Fax:580-699-5523
Practice Address - Street 1:713 SW C AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4311
Practice Address - Country:US
Practice Address - Phone:580-262-8945
Practice Address - Fax:580-699-5523
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator