Healthcare Provider Details

I. General information

NPI: 1427520899
Provider Name (Legal Business Name): LAURA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 09/20/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD #319
FRESNO CA
93702-3604
US

IV. Provider business mailing address

2223 N DIVISADERO ST
VISALIA CA
93291-1764
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-2382
  • Fax:
Mailing address:
  • Phone: 559-639-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: