Healthcare Provider Details

I. General information

NPI: 1639087422
Provider Name (Legal Business Name): ARIADNA CERVANTES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17284 SLOVER AVE
FONTANA CA
92337-7584
US

IV. Provider business mailing address

12136 HOPLAND ST
NORWALK CA
90650-6658
US

V. Phone/Fax

Practice location:
  • Phone: 800-464-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number93030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: