Provider Demographics
NPI:1669617502
Name:CANTU, LETICIA LAVITA (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:LAVITA
Last Name:CANTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:250 BLOSSOM ST
Mailing Address - Street 2:STE 400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4204
Mailing Address - Country:US
Mailing Address - Phone:281-604-1300
Mailing Address - Fax:281-724-0225
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE 400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-604-1300
Practice Address - Fax:281-724-0225
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CX002OtherBCBS
TX286128801Medicaid
TX6243476OtherCIGNA
TX9601728OtherAETNA
TXNONEMedicare UPIN
TX286128801Medicaid