Provider Demographics
NPI:1134572936
Name:CERVANTES, TRISHA N
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:N
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 N KENTUCKY ST
Mailing Address - Street 2:STE C
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1863
Mailing Address - Country:US
Mailing Address - Phone:903-819-0465
Mailing Address - Fax:
Practice Address - Street 1:1203 N KENTUCKY ST
Practice Address - Street 2:STE C
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1863
Practice Address - Country:US
Practice Address - Phone:903-819-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7521200001Medicare NSC