Basic Information
| Provider Information | |||||||||
| NPI: | 1093288920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERVANTES | ||||||||
| FirstName: | GIOVANNI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11211 PROSPERITY FARMS RD STE B104 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334103453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615374526 | ||||||||
| FaxNumber: | 5616343449 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615374526 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH12662 | FL | Y | Chiropractic Providers | Chiropractor |
No ID Information.