Provider Demographics
NPI:1972848497
Name:CERVERA-SERVIN, JOSE ANDRES (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE ANDRES
Middle Name:
Last Name:CERVERA-SERVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AV CLUB DE GOLF 61
Mailing Address - Street 2:CLUB DE GOLF, VALLESCONDIDO ATIZAPAN DE ZARAGOZA
Mailing Address - City:CIUDAD LOPEZ MATEOS
Mailing Address - State:ESTADO DE MEXICO
Mailing Address - Zip Code:52937
Mailing Address - Country:MX
Mailing Address - Phone:52555-813-8171
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-386-6600
Practice Address - Fax:206-386-2452
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFE.60326633208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery