Healthcare Provider Details

I. General information

NPI: 1083345268
Provider Name (Legal Business Name): MARIANA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16580 HARBOR BLVD STE O
FOUNTAIN VALLEY CA
92708-1396
US

IV. Provider business mailing address

16580 HARBOR BLVD STE O
FOUNTAIN VALLEY CA
92708-1396
US

V. Phone/Fax

Practice location:
  • Phone: 714-975-5201
  • Fax:
Mailing address:
  • Phone: 714-975-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: