Raul Cervantes, LVN II

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

291623 Issued in CA

Practice address

303 E Vanderbilt Way
San Bernardino, CA 92415-0026

Phone

(903) 987-7200

NPI assigned

Nov 29, 2022

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 29, 2022.

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1497465652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 N VERDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923764978",
            "telephone_number": "626-464-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E VANDERBILT WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150026",
            "telephone_number": "903-987-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVANTES",
        "first_name": "RAUL",
        "credential": "LVN II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "291623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "J6203",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "DPH",
            "affiliation": "N",
            "endpointDescription": "DPH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "DPH",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "DBH",
            "address_1": "678 N VERDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "country_code": "US",
            "postal_code": "92376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Earl Cephas, M.A
• Cesar Ernesto Cerda
• Vanessa Cereceres
• Jodi Cerney
• Maria Cerrito
• Raymond A Cervenka, PA
• Diana Alejandra Cevallos
• Anna Rosario Chacon, PA-C
• Katelynn Christine Chacon
• Gina T Chadwick

• All providers in San Bernardino, CA
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.