Provider Demographics
NPI:1437184686
Name:CANTU, VIRGILIO ARISTEO (MD)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:ARISTEO
Last Name:CANTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-423-3383
Mailing Address - Fax:877-469-3649
Practice Address - Street 1:540 E. ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90805-1476
Practice Address - Country:US
Practice Address - Phone:562-423-3383
Practice Address - Fax:877-469-3649
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A716920Medicaid
CAP01453339-DU4032OtherRAILROAD MEDICARE
CACB228321 - GB232AMedicare PIN
CAP01453339-DU4032OtherRAILROAD MEDICARE
CAA71692Medicare PIN
CAH53765Medicare UPIN