Basic Information
| Provider Information | |||||||||
| NPI: | 1174985816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERVANTES | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8530 FIRESTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628677999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8530 FIRESTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628677999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A168115 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | A168115 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.