Provider Demographics
NPI:1508873324
Name:CERVANTES, JUAN J (PA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4767
Mailing Address - Country:US
Mailing Address - Phone:630-801-0031
Mailing Address - Fax:
Practice Address - Street 1:330 WESTON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4767
Practice Address - Country:US
Practice Address - Phone:630-801-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ03460Medicare UPIN
ILK02607Medicare PIN