Provider Demographics
NPI:1699082966
Name:CERVANTES, CONSUELO (MPAP)
Entity type:Individual
Prefix:MRS
First Name:CONSUELO
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MPAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12729 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2873
Mailing Address - Country:US
Mailing Address - Phone:562-207-2270
Mailing Address - Fax:
Practice Address - Street 1:12729 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2873
Practice Address - Country:US
Practice Address - Phone:562-207-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical