Provider Demographics
NPI:1881033355
Name:CANTU, VLANCA MICHELLE (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:VLANCA
Middle Name:MICHELLE
Last Name:CANTU
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 S CHIPETA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1261
Mailing Address - Country:US
Mailing Address - Phone:801-585-0187
Mailing Address - Fax:
Practice Address - Street 1:375 S CHIPETA WAY STE A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1261
Practice Address - Country:US
Practice Address - Phone:801-585-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians