MEDICARE: GABRIELA CERVANTES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	58725	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1	OTHER	CA	STUDENT, HEALTH CARE

General Provider Information

NPI Number	:	1205082708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA CERVANTES DDS

Provider Business Mailing Address
First Line	:	3320 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808
Country	:	US
Telephone Number	:	562-377-1375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3918
Country	:	US
Telephone Number	:	562-377-1375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	03/17/2018

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