Provider Demographics
NPI:1740747658
Name:CERVANTES, YADIRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MANCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1785
Mailing Address - Country:US
Mailing Address - Phone:530-828-2801
Mailing Address - Fax:
Practice Address - Street 1:9220 MALLARD AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6424
Practice Address - Country:US
Practice Address - Phone:530-828-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician