Healthcare Provider Details

I. General information

NPI: 1477457034
Provider Name (Legal Business Name): TANIA M CERVANTES AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 222
UPLAND CA
91785-0222
US

IV. Provider business mailing address

PO BOX 222
UPLAND CA
91785-0222
US

V. Phone/Fax

Practice location:
  • Phone: 909-235-9738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: