Provider Demographics
NPI:1154196186
Name:CERVANTES, RAFAEL JR
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:CERVANTES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 VANCE JACKSON RD APT 3207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3218
Mailing Address - Country:US
Mailing Address - Phone:726-268-0020
Mailing Address - Fax:210-756-3025
Practice Address - Street 1:15503 VANCE JACKSON RD APT 3207
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3218
Practice Address - Country:US
Practice Address - Phone:726-268-0020
Practice Address - Fax:210-756-3025
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX022667372600000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty