Healthcare Provider Details

I. General information

NPI: 1194745703
Provider Name (Legal Business Name): LUISA CERVANTES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE RADIOLOGY DEPARTMENT
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 S W 62 AVENUE RADIOLOGY DEPARTMENT
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8293
  • Fax: 305-667-8689
Mailing address:
  • Phone: 305-662-8293
  • Fax: 305-667-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME92358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: