1861726093 NPI number — DANIELA CERVANTES-ELIA RN BSN MSN FNP

Table of content: DANIELA CERVANTES-ELIA RN BSN MSN FNP (NPI 1861726093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861726093 NPI number — DANIELA CERVANTES-ELIA RN BSN MSN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERVANTES-ELIA
Provider First Name:
DANIELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN BSN MSN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CERVANTES
Provider Other First Name:
DANIELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861726093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51544 HARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COACHELLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92236-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-398-3555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88775 AVENUE 76, STE. 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THERMAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92274-9407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-397-2501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  580301 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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