1851537856 NPI number — MISS MONIQUE L CANTU ASST SLP

Table of content: MISS MONIQUE L CANTU ASST SLP (NPI 1851537856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851537856 NPI number — MISS MONIQUE L CANTU ASST SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTU
Provider First Name:
MONIQUE
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ASST SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851537856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1228 S GUMWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-6022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-783-0854
Provider Business Mailing Address Fax Number:
956-262-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W EDINBURG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78543-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-262-1037
Provider Business Practice Location Address Fax Number:
956-262-7756
Provider Enumeration Date:
12/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  34739 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 183477202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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