Provider Demographics
NPI:1114717550
Name:CERVANTES, LUIS ANGEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:CERVANTES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MCGEE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1243
Mailing Address - Country:US
Mailing Address - Phone:805-324-0566
Mailing Address - Fax:
Practice Address - Street 1:2828 FORD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2114
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker