Provider Demographics
NPI:1639825672
Name:CANTU, REBECCA JENISS
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JENISS
Last Name:CANTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S TECATE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0125
Mailing Address - Country:US
Mailing Address - Phone:956-566-2729
Mailing Address - Fax:
Practice Address - Street 1:600 S TECATE DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0125
Practice Address - Country:US
Practice Address - Phone:956-566-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty