Provider Demographics
NPI:1598155830
Name:CANTU, MONICA EDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:EDITH
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 1:1890 LPGA BLVD STE 130
Mailing Address - Street 2:PRIMECARE AT TWIN LAKES
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7131
Mailing Address - Country:US
Mailing Address - Phone:386-274-2212
Mailing Address - Fax:386-274-1508
Practice Address - Street 1:1890 LPGA BLVD STE 130
Practice Address - Street 2:PRIMECARE AT TWIN LAKES
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7131
Practice Address - Country:US
Practice Address - Phone:386-274-2212
Practice Address - Fax:386-274-1508
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122370208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice