MEDICARE: DR. MARIA ELENA L. CANTU M.D.

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	207Q00000X	Family Medicine Physician	D7740	TX

General Provider Information

NPI Number	:	1225236888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ELENA L. CANTU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7469
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-0469
Country	:	US
Telephone Number	:	210-348-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 NW LOOP 410
Second Line	:	STE A
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5105
Country	:	US
Telephone Number	:	210-598-8035
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	03/10/2016

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