Healthcare Provider Details

I. General information

NPI: 1841985447
Provider Name (Legal Business Name): DAAE CANTU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201 BUCKNELL CIR
WESTMINSTER CA
92683-6213
US

IV. Provider business mailing address

15201 BUCKNELL CIR
WESTMINSTER CA
92683-6213
US

V. Phone/Fax

Practice location:
  • Phone: 714-307-2323
  • Fax:
Mailing address:
  • Phone: 714-397-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: