Provider Demographics
NPI:1669731410
Name:CERVANTES, TESSA JENE (MD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:JENE
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 PAESANOS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1268
Mailing Address - Country:US
Mailing Address - Phone:210-504-9668
Mailing Address - Fax:210-504-9668
Practice Address - Street 1:3603 PAESANOS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1268
Practice Address - Country:US
Practice Address - Phone:210-504-9668
Practice Address - Fax:210-892-3872
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ5773207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program