Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP129275 | TX |
NPI | 1003287301 |
---|---|
Provider Name | Mr. Nathaniel Gerardo Cervantes |
First Address | Brownsville, TX 78520-9037 |
Second Address | San Antonio, TX 78221-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |