Provider Demographics
NPI:1508405051
Name:CANTU, THERESA ANN (CPHT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:CANTU
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 ADAIR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5612
Mailing Address - Country:US
Mailing Address - Phone:512-300-9064
Mailing Address - Fax:
Practice Address - Street 1:1812 CENTRE CREEK DR STE 115
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5133
Practice Address - Country:US
Practice Address - Phone:512-579-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
TX105641183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No174H00000XOther Service ProvidersHealth Educator