Healthcare Provider Details

I. General information

NPI: 1205670452
Provider Name (Legal Business Name): PRISCILLA ROSE CANTU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6418 AZUL ST
EDINBURG TX
78542-0723
US

IV. Provider business mailing address

12312 TIQUISATE AVE
EDINBURG TX
78541-7066
US

V. Phone/Fax

Practice location:
  • Phone: 956-270-9262
  • Fax:
Mailing address:
  • Phone: 956-207-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: