MEDICARE: JERROLD CANTOR, MD, INC

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

General Provider Information

NPI Number	:	1336227792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERROLD CANTOR, MD, INC

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERROLD D CANTOR
Credential	:	MD
Telephone Number	:	714-751-0034

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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