Provider Demographics
NPI:1396426995
Name:CANTABRANA, JOSE ALEJANDRO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:CANTABRANA
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 1:2197 S 4TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6473
Mailing Address - Country:US
Mailing Address - Phone:928-388-5806
Mailing Address - Fax:
Practice Address - Street 1:2197 S 4TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6473
Practice Address - Country:US
Practice Address - Phone:928-388-5806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health