Healthcare Provider Details

I. General information

NPI: 1699617811
Provider Name (Legal Business Name): MICHAEL ANTHONY CERVANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4202
DOWNEY CA
90241-1202
US

IV. Provider business mailing address

PO BOX 4202
DOWNEY CA
90241-1202
US

V. Phone/Fax

Practice location:
  • Phone: 323-559-5095
  • Fax:
Mailing address:
  • Phone: 323-559-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: