Healthcare Provider Details

I. General information

NPI: 1780977512
Provider Name (Legal Business Name): JAMES RAE CANTU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 ROSE AVE
VENICE CA
90291-2767
US

IV. Provider business mailing address

7260 FM 1303
FLORESVILLE TX
78114-6458
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-8636
  • Fax:
Mailing address:
  • Phone: 979-739-3294
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61661052
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN9683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: