Provider Demographics
NPI:1336879881
Name:CERVANTES, MONICA (DPM)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE STE 417
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2439
Mailing Address - Country:US
Mailing Address - Phone:828-159-7163
Mailing Address - Fax:102-815-3196
Practice Address - Street 1:12121 RICHMOND AVE STE 417
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2439
Practice Address - Country:US
Practice Address - Phone:828-159-7163
Practice Address - Fax:102-815-3196
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT19-2022213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist