Provider Demographics
NPI:1821866278
Name:CERVANTES, ANGEL (CNA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W 1ST AVE APT 510
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4058
Mailing Address - Country:US
Mailing Address - Phone:509-381-9746
Mailing Address - Fax:
Practice Address - Street 1:17 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1201
Practice Address - Country:US
Practice Address - Phone:509-474-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60547071376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide