Healthcare Provider Details

I. General information

NPI: 1831678853
Provider Name (Legal Business Name): MARIA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY STE 508
VAN NUYS CA
91405-2289
US

IV. Provider business mailing address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-4990
  • Fax:
Mailing address:
  • Phone: 213-241-3305
  • Fax: 213-241-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89852
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: