Provider Demographics
NPI:1124004999
Name:LONGO, ADRIANA CERVANTES (MD)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:CERVANTES
Last Name:LONGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:CERVANTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12100 EUCLID ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3304
Mailing Address - Country:US
Mailing Address - Phone:714-741-3685
Mailing Address - Fax:
Practice Address - Street 1:12100 EUCLID ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3304
Practice Address - Country:US
Practice Address - Phone:714-741-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0183920Medicaid
MA0183920Medicaid
MAH75164Medicare UPIN