Provider Demographics
NPI:1912025149
Name:CERVANTES HEALTHCARE, LLLP
Entity Type:Organization
Organization Name:CERVANTES HEALTHCARE, LLLP
Other - Org Name:CECILIA M. CERVANTES, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:MARINA
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-636-6119
Mailing Address - Street 1:5114 BALCONES WOODS DR
Mailing Address - Street 2:SUITE 307-347
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5273
Mailing Address - Country:US
Mailing Address - Phone:512-466-2621
Mailing Address - Fax:888-550-6132
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1631207R00000X
2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114022753OtherNPI - DR. CECILIA M. CERVANTES
TX124383405Medicaid
TX0029ENOtherBLUE CROSS PROVIDER #
1114022753OtherNPI - DR. CECILIA M. CERVANTES