Healthcare Provider Details

I. General information

NPI: 1164216859
Provider Name (Legal Business Name): LESLIE CERVANTES LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 BELLEGRAVE AVE
JURUPA VALLEY CA
91752
US

IV. Provider business mailing address

3924 RIVERVIEW DR
JURUPA VALLEY CA
92509-6611
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-2660
  • Fax:
Mailing address:
  • Phone: 951-360-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: