Healthcare Provider Details

I. General information

NPI: 1871101618
Provider Name (Legal Business Name): LETICIA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LAMOILLE HWY STE 103
ELKO NV
89801-4397
US

IV. Provider business mailing address

3024 HAILEY CT
ELKO NV
89801-2477
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1292
  • Fax:
Mailing address:
  • Phone: 775-388-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0862
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: