Healthcare Provider Details

I. General information

NPI: 1285459727
Provider Name (Legal Business Name): ILDER CERVANTES SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43830 10TH ST W
LANCASTER CA
93534-4826
US

IV. Provider business mailing address

507 E NUGENT ST
LANCASTER CA
93535-3116
US

V. Phone/Fax

Practice location:
  • Phone: 661-494-8600
  • Fax:
Mailing address:
  • Phone: 661-777-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01204897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: