Provider Demographics
NPI:1184748543
Name:CERVANTES, PATRICIA ESCARENO (COA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ESCARENO
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 MIDNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7032
Mailing Address - Country:US
Mailing Address - Phone:210-381-0206
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR. SUITE 1
Practice Address - Street 2:159TH MEDICAL WING
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist