Healthcare Provider Details

I. General information

NPI: 1841503927
Provider Name (Legal Business Name): ALFEO CERVANTES II M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

541 S HIGHWAY 22 A
PANAMA CITY FL
32404-6849
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-6944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License NumberTN39280
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License NumberTN39280
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246QH0000X
TaxonomyHematology Specialist/Technologist
License NumberTN39280
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code246QI0000X
TaxonomyImmunology Pathology Specialist/Technologist
License NumberTN39280
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberTN39280
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code246QM0900X
TaxonomyMicrobiology Specialist/Technologist
License NumberTN 39280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: