Provider Demographics
NPI:1922393412
Name:CANTANDO, WENDY LEE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:CANTANDO
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 1:7701 E WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4233
Mailing Address - Country:US
Mailing Address - Phone:520-982-7675
Mailing Address - Fax:520-296-8244
Practice Address - Street 1:7701 E WAVERLY ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4233
Practice Address - Country:US
Practice Address - Phone:520-982-7675
Practice Address - Fax:520-296-8244
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2993134385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2993134OtherOLCR FOSTER CARE LICENSE