Healthcare Provider Details

I. General information

NPI: 1407079627
Provider Name (Legal Business Name): PATRICIA V CERVANTES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 ACADEMY DR
CORRALES NM
87048-8731
US

IV. Provider business mailing address

7100 IDALIA RD NE
RIO RANCHO NM
87144-7526
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-0596
  • Fax:
Mailing address:
  • Phone: 505-771-1466
  • Fax: 505-771-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06270
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: