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General NPI Number Information
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NPI Number | 1932064912
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Entity Type | Individual
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Provider Name | JUAN MANUEL CERVANTES
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Gender | Male
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 9021 9TH ST. APT A3
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City | BUENA PARK
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State | CA
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Zip | 90621
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Country | US
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Telephone | 657-452-1446
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Fax |
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Provider Business Mailing Address
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Address Line | 6930 BEACH BLVD
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City | BUENA PARK
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State | CA
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Zip | 90621-6816
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Country | US
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Telephone | 657-452-1446
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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