MEDICARE: DR. JESUS CERVANTES PSY D. LMFT

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	101Y00000X	Counselor	PSB31462	CA
2	106H00000X	Marriage & Family Therapist	MFC 48588	CA

General Provider Information

NPI Number	:	1871538306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS CERVANTES PSY D. LMFT

Provider Business Mailing Address
First Line	:	7001A EAST PKWY STE 300
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-9875
Fax Number	:	916-875-0877

Provider Business Practice Location Address
First Line	:	7001A EAST PKWY STE 300
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-9875
Fax Number	:	916-875-0877

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/31/2010

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