Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP143880 | TX |
NPI | 1053956623 |
---|---|
Provider Name | Gilbert Roman Cervantes |
First Address | San Antonio, TX 78258-1652 |
Second Address | San Antonio, TX 78235-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 07/11/2019 |