MEDICARE: JOSE L CERVANTES MD

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	207P00000X	Emergency Medicine Physician	A76360	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275589962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE L CERVANTES MD

Provider Business Mailing Address
First Line	:	PO BOX 2705-605
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647
Country	:	US
Telephone Number	:	562-809-3571
Fax Number	:	562-468-0347

Provider Business Practice Location Address
First Line	:	1601 N SEPULVEDA BLVD
Second Line	:	#543
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	424-217-3227
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	11/10/2014

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Directions to “ JOSE L CERVANTES MD” Practice Location

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