Provider Demographics
NPI:1689992695
Name:CERVANTES, BRENDA CRISTINA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CRISTINA
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 1:14703 OZARK SITE WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:281-723-3116
Mailing Address - Fax:
Practice Address - Street 1:24359 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-6100
Practice Address - Country:US
Practice Address - Phone:661-347-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical