MEDICARE: KASSANDRA CERVANTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1316875255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA CERVANTES

Provider Business Mailing Address
First Line	:	PO BOX 481
Second Line	:
City	:	WOODLAKE
State	:	CA
Zip	:	93286-0481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 7TH AVE STE 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-3912
Country	:	US
Telephone Number	:	408-835-6474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ KASSANDRA CERVANTES ” Practice Location

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