Healthcare Provider Details

I. General information

NPI: 1982186441
Provider Name (Legal Business Name): ANDREA CERVANTES-DIEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 09/22/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MILES LN
WATSONVILLE CA
95076-3127
US

IV. Provider business mailing address

15 COFFEY LN
FREEDOM CA
95019-2717
US

V. Phone/Fax

Practice location:
  • Phone: 831-761-5422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: