Provider Demographics
NPI:1457734675
Name:OTANEZ CERVANTES, JORGE ARMANDO (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ARMANDO
Last Name:OTANEZ CERVANTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2214
Mailing Address - Country:US
Mailing Address - Phone:760-871-0606
Mailing Address - Fax:858-634-6918
Practice Address - Street 1:1121 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-871-0606
Practice Address - Fax:858-634-6918
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153220207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine