Provider Demographics
NPI:1992012595
Name:CERVANTES, ELIDA LIBRADA (DPM)
Entity type:Individual
Prefix:
First Name:ELIDA
Middle Name:LIBRADA
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ELIDA
Other - Middle Name:LIBRADA
Other - Last Name:CERVANTES-GROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2115 BUSH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2115 BUSH DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3425
Practice Address - Country:US
Practice Address - Phone:956-655-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5599213E00000X
TX1952213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952OtherSTATE LICENSE