Provider Demographics
NPI:1932986387
Name:CERVANTES, JOAQUIN (RN-BSN)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 MCLEOD RD NE STE M
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2484
Mailing Address - Country:US
Mailing Address - Phone:505-200-2092
Mailing Address - Fax:
Practice Address - Street 1:5600 MCLEOD RD NE STE M
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2484
Practice Address - Country:US
Practice Address - Phone:505-200-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM421211163WS0200X
NM68671163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool