Provider Demographics
NPI:1194488809
Name:CERVANTES, SELENE
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:
Last Name: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 1:741 BRAVO DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0199
Mailing Address - Country:US
Mailing Address - Phone:805-509-7039
Mailing Address - Fax:
Practice Address - Street 1:4001 MISSION OAKS BLVD STE I
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5121
Practice Address - Country:US
Practice Address - Phone:805-485-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist