Provider Demographics
NPI:1841503927
Name:CERVANTES, ALFEO II (MT)
Entity type:Individual
Prefix:MR
First Name:ALFEO
Middle Name:
Last Name:CERVANTES
Suffix:II
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S HIGHWAY 22 A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3623
Practice Address - Country:US
Practice Address - Phone:850-747-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN39280246QB0000X, 246QH0000X, 246QI0000X, 246QM0706X
TN39280246QC1000X
FLTN 39280246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking
No246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
No246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematology
No246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology