Provider Demographics
NPI:1558432641
Name:CANTU, CYNTHIA GUADALUP (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GUADALUP
Last Name:CANTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 MEDICAL LOOP
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6612
Mailing Address - Country:US
Mailing Address - Phone:956-523-8900
Mailing Address - Fax:956-523-8903
Practice Address - Street 1:10410 MEDICAL LOOP
Practice Address - Street 2:UNIT 3B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6612
Practice Address - Country:US
Practice Address - Phone:956-523-8900
Practice Address - Fax:956-523-8903
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60132729OtherDPS
TX171139202Medicaid
TX8P9781OtherBLUE CROSS
TXL8003OtherLICENSE
TX171140001Medicaid
TX171140001Medicaid
TXL8003OtherLICENSE
TX171140001Medicaid
TX171139202Medicaid