Healthcare Provider Details

I. General information

NPI: 1346504727
Provider Name (Legal Business Name): REFUGIO CERVANTES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

14743 LA FORGE ST
WHITTIER CA
90603-1934
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5000
  • Fax:
Mailing address:
  • Phone: 562-789-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number21632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: