Provider Demographics
NPI:1376204768
Name:CANTU, DAVID JACOB
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JACOB
Last Name:CANTU
Suffix:
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 1:29660 STATE HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-7938
Mailing Address - Country:US
Mailing Address - Phone:956-456-8652
Mailing Address - Fax:
Practice Address - Street 1:2950 SOUTHMOST RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4787
Practice Address - Country:US
Practice Address - Phone:956-541-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist