Healthcare Provider Details

I. General information

NPI: 1295658904
Provider Name (Legal Business Name): JT NATUROPATHIC PROFESSIONAL LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

IV. Provider business mailing address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

V. Phone/Fax

Practice location:
  • Phone: 480-360-0456
  • Fax: 928-365-0100
Mailing address:
  • Phone: 480-360-0456
  • Fax: 928-365-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIO CANTILLO
Title or Position: CEO
Credential: NMD
Phone: 480-360-0456