Healthcare Provider Details

I. General information

NPI: 1184088411
Provider Name (Legal Business Name): CYNTHIA L CANTU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA L CANTU-GAMEZ

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 HIGHWAY 151
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

11212 HIGHWAY 151
SAN ANTONIO TX
78251-4498
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9901
  • Fax:
Mailing address:
  • Phone: 210-450-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS0264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: