Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1184748543 |
---|---|
Provider Name | Mrs. Patricia Escareno Cervantes |
First Address | San Antonio, TX 78258-7032 |
Second Address | Lackland Afb, TX 78236-9908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |