Provider Demographics
NPI:1962865055
Name:GARCIA CERVERA, DESDEMONA (SA-C)
Entity Type:Individual
Prefix:
First Name:DESDEMONA
Middle Name:
Last Name:GARCIA CERVERA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 EADS PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1813
Mailing Address - Country:US
Mailing Address - Phone:915-227-7081
Mailing Address - Fax:
Practice Address - Street 1:2907 EADS PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1813
Practice Address - Country:US
Practice Address - Phone:915-227-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-186246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant