Healthcare Provider Details

I. General information

NPI: 1477234250
Provider Name (Legal Business Name): CRYSTAL DOLORES CANTU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 SLIDE RD # D24
LUBBOCK TX
79414-4310
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0450
  • Fax: 806-796-7259
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1128709
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: