Provider Demographics
NPI:1992179139
Name:CANTON, LETICIA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MICHELLE
Last Name:CANTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KIRKSTALL DR APT 1210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6431
Mailing Address - Country:US
Mailing Address - Phone:832-882-5937
Mailing Address - Fax:
Practice Address - Street 1:300 KIRKSTALL DR APT 1210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-6431
Practice Address - Country:US
Practice Address - Phone:832-882-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18331950343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle