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General NPI Number Information
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NPI Number | 1740602978
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Entity Type | Individual
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Provider Name | JOSE LUIS CERVANTES
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Gender | Male
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1250 MORENA BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92110-3815
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Country | US
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Telephone | 619-692-8715
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Fax |
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Provider Business Mailing Address
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Address Line | 10767 JAMACHA BLVD SPC 38
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City | SPRING VALLEY
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State | CA
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Zip | 91978-1851
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Country | US
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Telephone | 619-228-3536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 156853
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License Number State | CA
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