Healthcare Provider Details

I. General information

NPI: 1629614466
Provider Name (Legal Business Name): KAYLA CANTU RN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

IV. Provider business mailing address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-7337
  • Fax:
Mailing address:
  • Phone: 623-877-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: