# MARIO CERVANTES, M.D., PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLINICA ANGELES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891931457
- **Authorized official:** DR. MARIO CERVANTES M.D. (PRESIDENT)
- **Authorized official phone:** (832) 638-6072

## Contact information

- **Practice address:** 4922 LOCUST ST, BELLAIRE, TX 77401-4040
- **Practice address phone:** (832) 638-6072
- **Practice address fax:** (888) 327-1505
- **Mailing address:** 5210 MAPLE ST, BELLAIRE, TX 77401
- **Mailing address phone:** (832) 638-6072
- **Mailing address fax:** (888) 327-1505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZH0000X | Hematology (Pathology) Physician | H7953 | TX | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | H7953 | TX | — |
| 208D00000X | General Practice Physician | H7953 | TX | Yes |

## Other

- **Enumeration date:** 12/31/2008
- **Last updated:** 11/19/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200034101 | — | TX |
| 01 | — | 45D2028678 | CLIA | TX |