Provider Demographics
NPI:1629224878
Name:CERVANTES, OSCAR F
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:F
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 EL CAMINO REAL
Mailing Address - Street 2:#209
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3426
Mailing Address - Country:US
Mailing Address - Phone:650-589-9442
Mailing Address - Fax:650-589-6943
Practice Address - Street 1:715 EL CAMINO REAL
Practice Address - Street 2:#209
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3426
Practice Address - Country:US
Practice Address - Phone:650-589-9442
Practice Address - Fax:650-589-6943
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical