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General NPI Number Information
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NPI Number | 1891931457
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Entity Type | Organization
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Legal Business Name | MARIO CERVANTES, M.D., PA
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 4922 LOCUST ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4040
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Country | US
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Telephone | 832-638-6072
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Fax | 888-327-1505
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Provider Business Mailing Address
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Address Line | 5210 MAPLE ST
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City | BELLAIRE
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State | TX
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Zip | 77401
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Country | US
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Telephone | 832-638-6072
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Fax | 888-327-1505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIO CERVANTES
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Credential | M.D.
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Telephone | 832-638-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | H7953
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | H7953
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | H7953
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License Number State | TX
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