Provider Demographics
NPI:1114022753
Name:CERVANTES, CECILIA MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARINA
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 BALCONES WOODS DR STE 307-347
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5273
Mailing Address - Country:US
Mailing Address - Phone:512-667-4343
Mailing Address - Fax:512-249-6119
Practice Address - Street 1:5114 BALCONES WOODS DR
Practice Address - Street 2:SUITE 307-347
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5273
Practice Address - Country:US
Practice Address - Phone:512-466-2621
Practice Address - Fax:888-550-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260620042083P0011X
TXJ1631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6127379OtherCIGNA PROVIDER NUMBER
TX0029ENOtherBLUE CROSS NUMBER
4299864OtherAETNA PROVIDER NUMBER
TX8AJ946OtherBLUE CROSS PROVIDER #
TX124383405Medicaid
TX80-0881204OtherTAX ID
TX0029ENOtherBLUE CROSS NUMBER
TX80-0881204OtherTAX ID