1972848497 NPI number — MR. JOSE ANDRES CERVERA-SERVIN MD

Table of content: MR. JOSE ANDRES CERVERA-SERVIN MD (NPI 1972848497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972848497 NPI number — MR. JOSE ANDRES CERVERA-SERVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERVERA-SERVIN
Provider First Name:
JOSE ANDRES
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972848497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AV CLUB DE GOLF 61
Provider Second Line Business Mailing Address:
CLUB DE GOLF, VALLESCONDIDO ATIZAPAN DE ZARAGOZA
Provider Business Mailing Address City Name:
CIUDAD LOPEZ MATEOS
Provider Business Mailing Address State Name:
ESTADO DE MEXICO
Provider Business Mailing Address Postal Code:
52937
Provider Business Mailing Address Country Code:
MX
Provider Business Mailing Address Telephone Number:
525558138171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 MADISON ST
Provider Second Line Business Practice Location Address:
510
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-6600
Provider Business Practice Location Address Fax Number:
206-386-2452
Provider Enumeration Date:
12/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  FE.60326633 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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