Healthcare Provider Details

I. General information

NPI: 1508405051
Provider Name (Legal Business Name): THERESA ANN CANTU CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CENTRE CREEK DR STE 115
AUSTIN TX
78754-5133
US

IV. Provider business mailing address

5808 ADAIR DR
AUSTIN TX
78754-5612
US

V. Phone/Fax

Practice location:
  • Phone: 512-579-0184
  • Fax:
Mailing address:
  • Phone: 512-300-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number105641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: