Provider Demographics
NPI:1124560776
Name:CERVANTES, VIVIANA BARAJAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:BARAJAS
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13322
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92170-3322
Mailing Address - Country:US
Mailing Address - Phone:619-723-1049
Mailing Address - Fax:
Practice Address - Street 1:895 E H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7807
Practice Address - Country:US
Practice Address - Phone:619-482-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist