MEDICARE: JOSE LUIS CERVANTES

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	106H00000X	Marriage & Family Therapist	156853	CA

General Provider Information

NPI Number	:	1740602978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS CERVANTES

Provider Business Mailing Address
First Line	:	10767 JAMACHA BLVD SPC 38
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1851
Country	:	US
Telephone Number	:	619-228-3536
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 MORENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8715
Fax Number	:

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

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	12/16/2025

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Directions to “ JOSE LUIS CERVANTES ” Practice Location

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