MEDICARE: IRMA MONSIVAIZ-CERVANTES MFTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF64789	CA

General Provider Information

NPI Number	:	1083918379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMA MONSIVAIZ-CERVANTES MFTI

Provider Business Mailing Address
First Line	:	31275 SAN MIGUELITO DR
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3148
Country	:	US
Telephone Number	:	760-799-4918
Fax Number	:

Provider Business Practice Location Address
First Line	:	74333 HIGHWAY 111 STE 205
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4131
Country	:	US
Telephone Number	:	760-797-5151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2010
Last Update Date	:	12/31/2010

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