Provider Demographics
NPI:1871341636
Name:CANTU, MARICELA TAIDE
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:TAIDE
Last Name:CANTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 BLISSFULL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1018
Mailing Address - Country:US
Mailing Address - Phone:281-779-1757
Mailing Address - Fax:
Practice Address - Street 1:10035 BLISSFULL VALLEY LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1018
Practice Address - Country:US
Practice Address - Phone:281-779-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-304059174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN