MEDICARE: JUSTINA SERVANTES

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1346173986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINA SERVANTES

Provider Business Mailing Address
First Line	:	2820 CLARK AVE
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-1903
Country	:	US
Telephone Number	:	951-736-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 MOUNTAIN GATE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-8858
Country	:	US
Telephone Number	:	951-739-5960
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ JUSTINA SERVANTES ” Practice Location

Language	Start Address	Practice Location

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