Provider Demographics
NPI:1881325280
Name:CANTU, JENNIFER J
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
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 1:13466 VERA MCGOWAN RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-8508
Mailing Address - Country:US
Mailing Address - Phone:956-230-1720
Mailing Address - Fax:
Practice Address - Street 1:13466 VERA MCGOWAN RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-8508
Practice Address - Country:US
Practice Address - Phone:225-380-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X
LA335563363A00000X
363A00000X
TXPA16541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant