Provider Demographics
NPI:1346719143
Name:CERVANTES, ERIN ELAYNE
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELAYNE
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 1:1360 N WINCHESTER BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1150
Mailing Address - Country:US
Mailing Address - Phone:408-709-2914
Mailing Address - Fax:
Practice Address - Street 1:REILLY BEHAVIORAL GROUP
Practice Address - Street 2:1360 NORTH WINCHESTER AVENUE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-709-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst