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General NPI Number Information
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NPI Number | 1790640878
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Entity Type | Individual
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Provider Name | JUAN CARLOS CERVANTES
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Gender | Male
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 9928 FLOWER ST STE 101
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City | BELLFLOWER
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State | CA
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Zip | 90706-5472
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Country | US
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Telephone | 562-737-7610
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Fax | 562-925-7572
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Provider Business Mailing Address
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Address Line | 9928 FLOWER ST STE 101
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City | BELLFLOWER
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State | CA
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Zip | 90706-5472
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Country | US
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Telephone | 562-737-7610
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Fax | 562-925-7572
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-1LDCQN
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License Number State | CA
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