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General NPI Number Information
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NPI Number | 1942037767
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Entity Type | Individual
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Provider Name | ERICK RICARDO CERVANTES ND
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Gender | Male
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 7956 CONVOY CT
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City | SAN DIEGO
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State | CA
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Zip | 92111-1212
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Country | US
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Telephone | 619-916-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 ROWLEY AVE
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City | RAMONA
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State | CA
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Zip | 92065-3213
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Country | US
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Telephone | 619-916-9120
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ND-559
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ND-559
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ND-559
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License Number State | CA
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