Provider Demographics
NPI:1912245994
Name:CERVANTES, JAIME EDUARDO
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:EDUARDO
Last Name:CERVANTES
Suffix:
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 1:3080 ARBOR PARK
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-2887
Mailing Address - Country:US
Mailing Address - Phone:956-280-3638
Mailing Address - Fax:
Practice Address - Street 1:3080 ARBOR PARK
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2887
Practice Address - Country:US
Practice Address - Phone:956-280-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160377164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse