Healthcare Provider Details

I. General information

NPI: 1447942149
Provider Name (Legal Business Name): EVELYN JHOANA CERVANTES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BRISTOL ST STE 100
COSTA MESA CA
92626-5996
US

IV. Provider business mailing address

2801 BRISTOL ST STE 100
COSTA MESA CA
92626-5996
US

V. Phone/Fax

Practice location:
  • Phone: 714-850-8408
  • Fax:
Mailing address:
  • Phone: 714-850-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: