MEDICARE: DR. MARICELA CANTU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	L8637	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L8637	OTHER	TX	STATE LICENSE #

General Provider Information

NPI Number	:	1225009491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARICELA CANTU D.O.

Provider Business Mailing Address
First Line	:	3919 WOODLAWN AVE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1996
Country	:	US
Telephone Number	:	713-941-7721
Fax Number	:	713-946-1950

Provider Business Practice Location Address
First Line	:	3919 WOODLAWN AVE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1996
Country	:	US
Telephone Number	:	713-941-7721
Fax Number	:	713-946-1950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/28/2014

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