Provider Demographics
NPI:1992416200
Name:CERVANTEZ, GREGORY P I
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:P
Last Name:CERVANTEZ
Suffix:I
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 1:1983 W LOSEY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3243
Mailing Address - Country:US
Mailing Address - Phone:309-342-2754
Mailing Address - Fax:
Practice Address - Street 1:1983 W LOSEY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3243
Practice Address - Country:US
Practice Address - Phone:309-342-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty