Provider Demographics
NPI:1972772994
Name:CANTERO, VICTOR H
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:CANTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5614
Mailing Address - Country:US
Mailing Address - Phone:954-510-5454
Mailing Address - Fax:954-510-5455
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-510-5454
Practice Address - Fax:954-510-5455
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME110277OtherDEPARTMENT OF HEALTH