Provider Demographics
NPI:1639750268
Name:CERVANTES, ABDIEL A I
Entity Type:Individual
Prefix:
First Name:ABDIEL
Middle Name:A
Last Name:CERVANTES
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 WYANT WAY
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1100
Mailing Address - Country:US
Mailing Address - Phone:509-203-0959
Mailing Address - Fax:
Practice Address - Street 1:214 ASH ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1319
Practice Address - Country:US
Practice Address - Phone:509-203-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC53055171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter