Roel E Cantu, M.D.
Individual provider Active NPI Pediatrics Physician · San Juan, TX
NPI 1902804123 · NPPES record last updated Jul 29, 2010
Key facts
- NPI
- 1902804123
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- L4876 (TX)
- Practice address
- 411 W FM 495
San Juan, TX 78589-3717 - Phone
- (956) 787-8100
- Fax
- (956) 787-8117
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170516000087 | TX | Practitioner - Pediatric Medicine | 4183931561 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L4876 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cantu Family Medical Clinic Professional Limited Liability Company | Current |
Accepting new patients | |
| Upper Valley Pediatric and Adolescent Healthcare Clinic PA | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | L4876 | TX | Yes |
Addresses
Primary practice location
411 W FM 495
San Juan, TX 78589-3717
Mailing address
411 W FM 495
San Juan, TX 78589-3717
Phone (956) 787-8100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 155370301 | Medicaid | TX |
Other providers in San Juan, TX
- Rosanna Buenrostor
- Building Bridges Therapy Clinic, LLC
- Luis E Calderon
- Cantu Family Medical Clinic Professional Limited Liability Company
- Christopher Robert Cantu
- Evelyn Jeanette Cardenas
- Connie Carlos
- Herlinda Roseanne Casarez
- Migdalia Cerda
- Certus Transportation Group LLC
All providers in San Juan, TX · Pediatrics Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.