Provider Demographics
NPI:1093200982
Name:ESTEVEZ CERVANTES, LENNA
Entity Type:Individual
Prefix:
First Name:LENNA
Middle Name:
Last Name:ESTEVEZ CERVANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10744 SW 173RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4156
Mailing Address - Country:US
Mailing Address - Phone:786-619-4368
Mailing Address - Fax:
Practice Address - Street 1:10744 SW 173RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-4156
Practice Address - Country:US
Practice Address - Phone:786-619-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020783400Medicaid