Provider Demographics
NPI:1396179131
Name:CERVANTES, FERNANDO JR (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:CERVANTES
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 MAPLE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9143
Mailing Address - Country:US
Mailing Address - Phone:805-654-0926
Mailing Address - Fax:805-654-0949
Practice Address - Street 1:3585 MAPLE ST STE 205
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9143
Practice Address - Country:US
Practice Address - Phone:805-654-0926
Practice Address - Fax:805-654-0949
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016203363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health