Healthcare Provider Details

I. General information

NPI: 1174436562
Provider Name (Legal Business Name): JOSE CERVANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 BUCHANAN AVE
HENDERSON NV
89015-7004
US

IV. Provider business mailing address

527 BUCHANAN AVE
HENDERSON NV
89015-7004
US

V. Phone/Fax

Practice location:
  • Phone: 702-850-2500
  • Fax:
Mailing address:
  • Phone: 702-850-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1601689102
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: