Provider Demographics
NPI:1265603518
Name:GERARDO CERVANTES
Entity type:Organization
Organization Name:GERARDO CERVANTES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:830-758-0006
Mailing Address - Street 1:2320 DEL RIO BLVD
Mailing Address - Street 2:PMB 60
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3980
Mailing Address - Country:US
Mailing Address - Phone:830-758-0006
Mailing Address - Fax:830-758-0009
Practice Address - Street 1:950 DR. AK MITTAL DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-758-0006
Practice Address - Fax:830-758-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195876102Medicaid
TX195876103Medicaid
TX195876101Medicaid
TX195876101Medicaid