Provider Demographics
NPI:1306141536
Name:CANTU, RANDI CATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:CATHLEEN
Last Name:CANTU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2840
Mailing Address - Country:US
Mailing Address - Phone:210-425-5047
Mailing Address - Fax:830-715-0582
Practice Address - Street 1:1201 S MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2840
Practice Address - Country:US
Practice Address - Phone:210-425-5047
Practice Address - Fax:830-715-0582
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional