Provider Demographics
NPI:1558990226
Name:YVONNE-CERVANTES, CERRENE
Entity Type:Individual
Prefix:DR
First Name:CERRENE
Middle Name:
Last Name:YVONNE-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 1:646 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4251
Mailing Address - Country:US
Mailing Address - Phone:916-747-5965
Mailing Address - Fax:
Practice Address - Street 1:7171 BOWLING DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2043
Practice Address - Country:US
Practice Address - Phone:916-747-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty