Provider Demographics
NPI:1457909848
Name:CERVANTES, ARIANA
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:
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 1:31772 CASINO DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31772 CASINO DR STE A
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4502
Practice Address - Country:US
Practice Address - Phone:760-761-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-01-03
Deactivation Date:2023-12-19
Deactivation Code:
Reactivation Date:2024-01-03
Provider Licenses
StateLicense IDTaxonomies
CA898421041C0700X, 1041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical