Healthcare Provider Details

I. General information

NPI: 1699350959
Provider Name (Legal Business Name): JOHARA USUDAN CANTU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 BUDDY OWENS AVE STE 300
MCALLEN TX
78504-6545
US

IV. Provider business mailing address

2402 E 27TH ST
MISSION TX
78574-1914
US

V. Phone/Fax

Practice location:
  • Phone: 956-627-5245
  • Fax:
Mailing address:
  • Phone: 832-274-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1022927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: