Provider Demographics
NPI:1285459727
Name:CERVANTES SANCHEZ, ILDER
Entity type:Individual
Prefix:
First Name:ILDER
Middle Name:
Last Name:CERVANTES SANCHEZ
Suffix:
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 1:507 E NUGENT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3116
Mailing Address - Country:US
Mailing Address - Phone:661-777-4098
Mailing Address - Fax:
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:661-494-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01204897376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide