Provider Demographics
NPI:1316953581
Name:CERVANTES, CECILIA D (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:D
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12239 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3238
Mailing Address - Country:US
Mailing Address - Phone:718-835-1056
Mailing Address - Fax:718-835-2769
Practice Address - Street 1:12239 135TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3238
Practice Address - Country:US
Practice Address - Phone:718-835-1056
Practice Address - Fax:718-835-2769
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1481052080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0546931-008OtherCIGNA HEALTHCARE
NY221529OtherWELLCARE
NY01359200Medicaid
NY62228520OtherATLANTIS HEALTH PLAN
NY2122776OtherAETNA HMO
NYIC7303OtherHEALTHNET
NY21E741OtherEMPIRE BLUE CROSS BLUE SH
NY4229484OtherAETNA PPO
NYAA46377AOtherMDNY
NYP1065136OtherOXFORD HEALTH PLAN
NY62228520OtherATLANTIS HEALTH PLAN