Provider Demographics
NPI:1407428949
Name:CERVANIA, JESSICA CABALCE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CABALCE
Last Name:CERVANIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 FLAGSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1799
Mailing Address - Country:US
Mailing Address - Phone:707-805-1400
Mailing Address - Fax:
Practice Address - Street 1:2751 NAPPY VALLEY CORPORATE DRIVE, BLDG. B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-210-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712250164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse