Healthcare Provider Details

I. General information

NPI: 1538640388
Provider Name (Legal Business Name): NOEL CARLO CERVANTES RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

604 TEXAS ST
POMONA CA
91768-3540
US

V. Phone/Fax

Practice location:
  • Phone: 626-851-7247
  • Fax:
Mailing address:
  • Phone: 909-766-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number38279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: