MEDICARE: DR. JERROLD DAVID CANTOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G23528	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063547792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERROLD DAVID CANTOR M.D.

Provider Business Mailing Address
First Line	:	2621 S BRISTOL ST STE 305
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5719
Country	:	US
Telephone Number	:	714-751-0034
Fax Number	:	714-751-1132

Provider Business Practice Location Address
First Line	:	2621 S BRISTOL ST STE 305
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5719
Country	:	US
Telephone Number	:	714-751-0034
Fax Number	:	714-751-1132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/04/2011

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