Healthcare Provider Details

I. General information

NPI: 1144149154
Provider Name (Legal Business Name): JAZMIN CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 18TH AVE N
NAMPA ID
83687-3555
US

IV. Provider business mailing address

712 18TH AVE N
NAMPA ID
83687-3555
US

V. Phone/Fax

Practice location:
  • Phone: 626-377-3760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: