Healthcare Provider Details

I. General information

NPI: 1730817602
Provider Name (Legal Business Name): YESENIA CANTU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 11/06/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13737 TX-36
NEEDVILLE TX
77461
US

IV. Provider business mailing address

13737 TX-36
NEEDVILLE TX
77461
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-3940
  • Fax:
Mailing address:
  • Phone: 979-793-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15944
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: