Provider Demographics
NPI:1407299738
Name:CERVANTES, ROSEMARY (MASTERS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E CENTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4648
Mailing Address - Country:US
Mailing Address - Phone:209-239-5978
Mailing Address - Fax:
Practice Address - Street 1:19 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4107
Practice Address - Country:US
Practice Address - Phone:209-239-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT127214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist