Healthcare Provider Details

I. General information

NPI: 1790640878
Provider Name (Legal Business Name): JUAN CARLOS CERVANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9928 FLOWER ST STE 101
BELLFLOWER CA
90706-5472
US

IV. Provider business mailing address

9928 FLOWER ST STE 101
BELLFLOWER CA
90706-5472
US

V. Phone/Fax

Practice location:
  • Phone: 562-737-7610
  • Fax: 562-925-7572
Mailing address:
  • Phone: 562-737-7610
  • Fax: 562-925-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-1LDCQN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: