Provider Demographics
NPI:1275719809
Name:CERVANTES, GERARDO
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 DEL RIO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3624
Mailing Address - Country:US
Mailing Address - Phone:830-758-0006
Mailing Address - Fax:830-758-0009
Practice Address - Street 1:2320 DEL RIO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3624
Practice Address - Country:US
Practice Address - Phone:830-758-0006
Practice Address - Fax:830-758-0009
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies