=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568333474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBERTO CANTU LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1249 E KIBER ST
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-5101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-410-5754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 GAGE DR STE J
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65672-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-410-5754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALBERTO CANTU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 929-410-5754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------