Provider Demographics
NPI:1568286425
Name:CERVANTES-DIEGO, AURA CARIDAD
Entity type:Individual
Prefix:
First Name:AURA
Middle Name:CARIDAD
Last Name:CERVANTES-DIEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COFFEY LN
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-2717
Mailing Address - Country:US
Mailing Address - Phone:831-728-8713
Mailing Address - Fax:
Practice Address - Street 1:104 WALNUT AVE STE 208
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3929
Practice Address - Country:US
Practice Address - Phone:831-423-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker