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General NPI Number Information
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NPI Number | 1548920184
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Entity Type | Individual
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Provider Name | DAVID JAMES CERVANTES-VIBAT JR. MOT
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Gender | Male
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 167 LIMESTONE DR
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City | VALLEJO
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State | CA
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Zip | 94589-2177
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Country | US
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Telephone | 707-319-0674
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Fax |
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Provider Business Mailing Address
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Address Line | 114 BANBURY WAY
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-4118
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Country | US
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Telephone | 707-319-0674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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