Provider Demographics
NPI:1558077107
Name:CERVANTES, ALBERTO RAMON
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:RAMON
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 1:1670 GATEHOUSE CIR N APT 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2919
Mailing Address - Country:US
Mailing Address - Phone:719-464-2397
Mailing Address - Fax:
Practice Address - Street 1:202 E CHEYENNE MOUNTAIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3769
Practice Address - Country:US
Practice Address - Phone:719-375-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist