Provider Demographics
NPI:1972079838
Name:CANTU-ROMO, MARIA MAGDALENA (THM, MS, LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MAGDALENA
Last Name:CANTU-ROMO
Suffix:
Gender:F
Credentials:THM, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3768
Mailing Address - Country:US
Mailing Address - Phone:877-566-4046
Mailing Address - Fax:887-632-4669
Practice Address - Street 1:1126 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3768
Practice Address - Country:US
Practice Address - Phone:877-566-4046
Practice Address - Fax:887-632-4669
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist