Healthcare Provider Details

I. General information

NPI: 1457784365
Provider Name (Legal Business Name): MONICA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5209
US

IV. Provider business mailing address

4130 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5209
US

V. Phone/Fax

Practice location:
  • Phone: 405-267-3246
  • Fax:
Mailing address:
  • Phone: 562-313-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: