Provider Demographics
NPI:1497770036
Name:SERVIN, MARGARET GARDEA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:GARDEA
Last Name:SERVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ALICE
Other - Last Name:GARDEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1395 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7410
Mailing Address - Country:US
Mailing Address - Phone:915-298-7222
Mailing Address - Fax:915-298-7237
Practice Address - Street 1:1395 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-298-7222
Practice Address - Fax:915-298-7237
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680014716OtherRAILROAD
TX83298POtherBCBS
TX149474201Medicaid
TX83298POtherBCBS
TX149474201Medicaid