MEDICARE: SALVINEO CERVANTES M.S., ATC/LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT4054	TX

General Provider Information

NPI Number	:	1134670151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALVINEO CERVANTES M.S., ATC/LAT

Provider Business Mailing Address
First Line	:	10206 CURLEW CRK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4854
Country	:	US
Telephone Number	:	210-632-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	10206 CURLEW CRK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4854
Country	:	US
Telephone Number	:	210-632-3627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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