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General NPI Number Information
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NPI Number | 1104093764
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Entity Type | Individual
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Provider Name | YOLANDA S CERVANTES DMD
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Gender | Female
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 208 E CARSON ST SUITE 200
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City | CARSON
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State | CA
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Zip | 90745-2700
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Country | US
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Telephone | 310-830-2624
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Fax | 310-830-4464
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Provider Business Mailing Address
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Address Line | 208 E CARSON ST SUITE 200
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City | CARSON
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State | CA
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Zip | 90745-2700
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Country | US
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Telephone | 310-830-2624
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Fax | 310-830-4464
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36614
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License Number State | CA
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