Provider Demographics
NPI:1548920184
Name:CERVANTES-VIBAT, DAVID JAMES JR (MOT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:CERVANTES-VIBAT
Suffix:JR
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BANBURY WAY
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-4118
Mailing Address - Country:US
Mailing Address - Phone:707-319-0674
Mailing Address - Fax:
Practice Address - Street 1:167 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2177
Practice Address - Country:US
Practice Address - Phone:707-319-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health