Healthcare Provider Details

I. General information

NPI: 1700549151
Provider Name (Legal Business Name): MIRIAM CABRERA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

4465 BOCA WAY SPC 217
RENO NV
89502-6440
US

V. Phone/Fax

Practice location:
  • Phone: 720-966-8200
  • Fax:
Mailing address:
  • Phone: 775-342-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: