Provider Demographics
NPI:1578258232
Name:CANTA, JERWIN REYES (LVN)
Entity Type:Individual
Prefix:
First Name:JERWIN
Middle Name:REYES
Last Name:CANTA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4106
Mailing Address - Country:US
Mailing Address - Phone:415-238-2396
Mailing Address - Fax:
Practice Address - Street 1:6100 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2001
Practice Address - Country:US
Practice Address - Phone:650-992-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716079164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse