Healthcare Provider Details

I. General information

NPI: 1114300506
Provider Name (Legal Business Name): ESMERALDA CERVANTES CROTEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESMERALDA CERVANTES

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

1330 E COOLEY DR
COLTON CA
92324-3905
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3705
  • Fax: 909-580-3747
Mailing address:
  • Phone: 909-580-3705
  • Fax: 909-580-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: