Provider Demographics
NPI:1811490238
Name:CERVANTES, ROBERTA I (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:I
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 E CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3940
Mailing Address - Country:US
Mailing Address - Phone:951-394-2087
Mailing Address - Fax:855-395-0872
Practice Address - Street 1:897 E CHASE DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3940
Practice Address - Country:US
Practice Address - Phone:951-212-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-21056163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811490238Other163WL0100X