Provider Demographics
NPI:1215063813
Name:CERVINO, MARIO (DC)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:CERVINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27574 COMMERCE CENTER DR
Mailing Address - Street 2:STE 131
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2535
Mailing Address - Country:US
Mailing Address - Phone:951-389-8881
Mailing Address - Fax:951-389-8881
Practice Address - Street 1:27574 COMMERCE CENTER DR
Practice Address - Street 2:STE 131
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2535
Practice Address - Country:US
Practice Address - Phone:951-389-8881
Practice Address - Fax:951-389-8881
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32022111N00000X
NJ38MC00387500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5326401-01Medicaid
NJ678844Medicare ID - Type Unspecified