Provider Demographics
NPI:1194745703
Name:CERVANTES, LUISA (MD)
Entity type:Individual
Prefix:MRS
First Name:LUISA
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 S W 62 AVENUE
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-662-8293
Mailing Address - Fax:305-667-8689
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8293
Practice Address - Fax:305-667-8689
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME923582085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273933000Medicaid