MEDICARE: JUAN CARLOS 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	175T00000X	Peer Specialist	MPSS-1LDCQN	CA

General Provider Information

NPI Number	:	1790640878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS CERVANTES

Provider Business Mailing Address
First Line	:	9928 FLOWER ST STE 101
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5472
Country	:	US
Telephone Number	:	562-737-7610
Fax Number	:	562-925-7572

Provider Business Practice Location Address
First Line	:	9928 FLOWER ST STE 101
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5472
Country	:	US
Telephone Number	:	562-737-7610
Fax Number	:	562-925-7572

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ JUAN CARLOS CERVANTES ” Practice Location

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