Provider Demographics
NPI:1568228468
Name:CERVANTES, JESUS (MPH, RDN)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 WHITE LN STE A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-8941
Mailing Address - Country:US
Mailing Address - Phone:661-398-2251
Mailing Address - Fax:
Practice Address - Street 1:5101 WHITE LN STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-8941
Practice Address - Country:US
Practice Address - Phone:661-398-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86057100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered