Provider Demographics
NPI:1083918379
Name:MONSIVAIZ-CERVANTES, IRMA (MFTI)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:MONSIVAIZ-CERVANTES
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31275 SAN MIGUELITO DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3148
Mailing Address - Country:US
Mailing Address - Phone:760-799-4918
Mailing Address - Fax:
Practice Address - Street 1:74333 HIGHWAY 111 STE 205
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4131
Practice Address - Country:US
Practice Address - Phone:760-797-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF64789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist