MEDICARE: MIGUEL ANGEL CERVANTES-LOPEZ PA-C

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	207Q00000X	Family Medicine Physician	PA20071	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA20071	OTHER	CA	STATE LIC

General Provider Information

NPI Number	:	1689829327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ANGEL CERVANTES-LOPEZ PA-C

Provider Business Mailing Address
First Line	:	6485 DAY ST.
Second Line	:	STE 201
City	:	RIVERSIDE
State	:	CA
Zip	:	92507
Country	:	US
Telephone Number	:	951-697-4549
Fax Number	:	951-697-4286

Provider Business Practice Location Address
First Line	:	1310 SAN BERNARDINO RD STE 103
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4985
Country	:	US
Telephone Number	:	909-920-0444
Fax Number	:

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

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	07/25/2023

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Directions to “ MIGUEL ANGEL CERVANTES-LOPEZ PA-C” Practice Location

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