Provider Demographics
NPI:1154358935
Name:CERVANTES, SAMUEL JOSE (BS, ATC)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSE
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2152
Mailing Address - Country:US
Mailing Address - Phone:619-850-7219
Mailing Address - Fax:
Practice Address - Street 1:5152 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2526
Practice Address - Country:US
Practice Address - Phone:805-681-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer