Provider Demographics
NPI:1952081994
Name:CERVANTES NIXON, SUSANA
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:CERVANTES NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11115 N LA CANADA DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9462
Mailing Address - Country:US
Mailing Address - Phone:520-451-4544
Mailing Address - Fax:
Practice Address - Street 1:11115 N LA CANADA DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9462
Practice Address - Country:US
Practice Address - Phone:520-451-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist