Provider Demographics
NPI:1396354692
Name:CERVANTES GARCIA, SYLVIA E
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:E
Last Name:CERVANTES GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:E
Other - Last Name:GARCIA CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 ATWATER ST N
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-1801
Mailing Address - Country:US
Mailing Address - Phone:503-378-7526
Mailing Address - Fax:503-480-1613
Practice Address - Street 1:180 ATWATER ST N
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1801
Practice Address - Country:US
Practice Address - Phone:503-378-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2166172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker