Provider Demographics
NPI:1427831296
Name:CERVANTES MONTALVO, DULCE (LMT)
Entity type:Individual
Prefix:
First Name:DULCE
Middle Name:
Last Name:CERVANTES MONTALVO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 ARCADIAN TRL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3404
Mailing Address - Country:US
Mailing Address - Phone:505-415-1777
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NM MSC09-3870
Practice Address - Street 2:
Practice Address - City:ABQ
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9697225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist