Miguel Angel Cervantes-Lopez, PA-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA20071 Issued in CA

Practice address

1310 San Bernardino Rd Ste 103
Upland, CA 91786-4985

Phone

(909) 920-0444

NPI assigned

Nov 21, 2008

Last updated

Jul 25, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chino Medical Group, Inc

  dba My Family Medical Group

  • Health Maintenance Organization
  • Chino, CA
  • NPI 1790730786
  Medicare reassignment
• Basim Z. Abdelkarim, M.D., Inc.

  dba Ideal Gastroenterology Associates

  • Gastroenterology Physician
  • Upland, CA
  • NPI 1063593739
  NPD (past)
• Rogelio Drenning-Manrriquez

  • General Practice Physician
  • Riverside, CA
  • NPI 1063999431
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1689829327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6485 DAY ST.",
            "address_2": "STE 201",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92507",
            "telephone_number": "951-697-4549",
            "fax_number": "951-697-4286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD STE 103",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864985",
            "telephone_number": "909-920-0444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6485 Day St.",
            "address_2": "STE 201",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "92507",
            "country_code": "US",
            "telephone_number": "951-697-4549",
            "fax_number": "951-697-4286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CERVANTES-LOPEZ",
        "first_name": "MIGUEL",
        "middle_name": "ANGEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-21",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA20071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC",
            "identifier": "PA20071",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Hospice Care, Inc.
• Centrelake Medical Group Inc (Centrelake Imaging & Oncology)
• Ceravo
• Ceravo Care Inc.
• Noemi Cerda Montoya
• Melissa V Cervantes
• Michael Cervantes, D.D.S.
• Rebecca Cervantez
• Michael Chai, M.D.
• Leslie Guadalupe Chaires

• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.