Healthcare Provider Details

I. General information

NPI: 1215735261
Provider Name (Legal Business Name): MS. LUISA MARIE CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 W NORTHWEST HWY
DALLAS TX
75225-4201
US

IV. Provider business mailing address

6711 W NORTHWEST HWY
DALLAS TX
75225-4201
US

V. Phone/Fax

Practice location:
  • Phone: 214-739-2225
  • Fax: 214-739-2228
Mailing address:
  • Phone: 214-739-2225
  • Fax: 214-739-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number8F21721
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: