Provider Demographics
NPI:1215427851
Name:CANTU, PRISCILA DOLORES
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:DOLORES
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 1:7304 ROBERT MICHAELS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-4223
Mailing Address - Country:US
Mailing Address - Phone:956-313-8281
Mailing Address - Fax:
Practice Address - Street 1:7304 ROBERT MICHAELS ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-4223
Practice Address - Country:US
Practice Address - Phone:956-257-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications