Provider Demographics
NPI:1003134263
Name:CERVANTES, BLANCA GUADALUPE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:GUADALUPE
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 N BUSH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2852
Mailing Address - Country:US
Mailing Address - Phone:714-294-6705
Mailing Address - Fax:714-884-4149
Practice Address - Street 1:1800 N BUSH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2852
Practice Address - Country:US
Practice Address - Phone:714-294-6705
Practice Address - Fax:714-884-4149
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1191382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry