Provider Demographics
NPI:1538119441
Name:CANTARTZOGLOU, STAVRO Y JR
Entity type:Individual
Prefix:MR
First Name:STAVRO
Middle Name:Y
Last Name:CANTARTZOGLOU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:Y
Other - Last Name:CANT
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 W ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6252
Mailing Address - Country:US
Mailing Address - Phone:626-852-9207
Mailing Address - Fax:
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-852-9207
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist