Provider Demographics
NPI:1245625201
Name:CANTU FAMILY MEDICAL CLINIC PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:CANTU FAMILY MEDICAL CLINIC PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROEL
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-8100
Mailing Address - Street 1:PO BOX 2419
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-7419
Mailing Address - Country:US
Mailing Address - Phone:956-787-5303
Mailing Address - Fax:956-787-8117
Practice Address - Street 1:409 W FM 495
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3717
Practice Address - Country:US
Practice Address - Phone:956-787-5303
Practice Address - Fax:956-787-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty