MEDICARE: RACHELLE CANTU

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821696337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE CANTU

Provider Business Mailing Address
First Line	:	2530 S COMMERCE ST BLDG B
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-5519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 RANCH RD
Second Line	:
City	:	RATLIFF CITY
State	:	OK
Zip	:	73481-8077
Country	:	US
Telephone Number	:	580-223-5636
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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Directions to “ RACHELLE CANTU ” Practice Location

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