Provider Demographics
NPI:1053693580
Name:CANTU, JUAN CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:CANTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:CARLOS
Other - Last Name:CANTU GALAVIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7359 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-6061
Mailing Address - Country:US
Mailing Address - Phone:407-900-9284
Mailing Address - Fax:407-203-8887
Practice Address - Street 1:7359 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-6061
Practice Address - Country:US
Practice Address - Phone:407-900-9284
Practice Address - Fax:407-203-8887
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18320208D00000X
FLACN673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice