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General NPI Number Information
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NPI Number | 1124712062
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Entity Type | Individual
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Provider Name | MARITZA CANTARERO FNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1374
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Country | US
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Telephone | 717-770-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 611 CENTER ST
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City | PASADENA
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State | TX
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Zip | 77506-2408
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Country | US
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Telephone | 713-385-6674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1117387
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License Number State | TX
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