Healthcare Provider Details

I. General information

NPI: 1689585978
Provider Name (Legal Business Name): MISTY CERVANTES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23751 CANERWELL ST
NEWHALL CA
91321-3713
US

IV. Provider business mailing address

43414 BUSINESS PARK DR
TEMECULA CA
92590-5526
US

V. Phone/Fax

Practice location:
  • Phone: 951-583-1548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: