Healthcare Provider Details

I. General information

NPI: 1548896772
Provider Name (Legal Business Name): LA MONICA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 PALM AVE
SAN DIEGO CA
92154-8404
US

IV. Provider business mailing address

4650 PALM AVE
SAN DIEGO CA
92154-8404
US

V. Phone/Fax

Practice location:
  • Phone: 877-496-0450
  • Fax:
Mailing address:
  • Phone: 858-256-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162311
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: