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General NPI Number Information
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NPI Number | 1912025149
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Entity Type | Organization
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Legal Business Name | CERVANTES HEALTHCARE, LLLP
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 5114 BALCONES WOODS DR SUITE 307-347
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City | AUSTIN
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State | TX
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Zip | 78759-5273
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Country | US
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Telephone | 512-466-2621
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Fax | 888-550-6132
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Provider Business Mailing Address
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Address Line | 5114 BALCONES WOODS DR SUITE 307-347
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City | AUSTIN
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State | TX
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Zip | 78759-5273
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Country | US
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Telephone | 512-466-2621
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Fax | 888-550-6132
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CECILIA MARINA CERVANTES
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Credential | M.D.
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Telephone | 512-636-6119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J1631
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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