Provider Demographics
NPI:1871839258
Name:CERVANTEZ, ANDREA SARAH
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SARAH
Last Name:CERVANTEZ
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 1:1495 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2303
Mailing Address - Country:US
Mailing Address - Phone:626-798-0907
Mailing Address - Fax:
Practice Address - Street 1:1495 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2303
Practice Address - Country:US
Practice Address - Phone:626-798-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program