Basic Information
| Provider Information | |||||||||
| NPI: | 1376535203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTU | ||||||||
| FirstName: | UVALDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 HAINE DR | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564254901 | ||||||||
| FaxNumber: | 9564254959 | ||||||||
| Practice Location | |||||||||
| Address1: | 2230 HAINE DR | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564254901 | ||||||||
| FaxNumber: | 9564254959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | H2286 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 136856504 | 05 | TX | MEDICAID | 88Y940 | 01 | TX | MEDICARE PROVIDER NO. | OTHER | 136856501 | 05 | TX | MEDICAID |