Provider Demographics
NPI:1295492858
Name:CERVANTES, MARIA ISABEL (LVN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BOSTON CT APT 21
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7692
Mailing Address - Country:US
Mailing Address - Phone:707-367-5602
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY STE 207
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5486
Practice Address - Country:US
Practice Address - Phone:707-565-4810
Practice Address - Fax:707-565-4907
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720697164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse