Provider Demographics
NPI:1932064912
Name:CERVANTES, JUAN MANUEL
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-6816
Mailing Address - Country:US
Mailing Address - Phone:657-452-1446
Mailing Address - Fax:
Practice Address - Street 1:9021 9TH ST.
Practice Address - Street 2:APT A3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:657-452-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-22
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor