Provider Demographics
NPI:1285726638
Name:CERVANTES, PHOEBE (PHD)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 CENTER COURT DR
Mailing Address - Street 2:STE 104
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3667
Mailing Address - Country:US
Mailing Address - Phone:626-966-5644
Mailing Address - Fax:626-339-7552
Practice Address - Street 1:1272 CENTER COURT DR
Practice Address - Street 2:STE 104
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3667
Practice Address - Country:US
Practice Address - Phone:626-966-5644
Practice Address - Fax:626-339-7552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9689103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954224169OtherBLUE CROSS ID
CA954224169OtherMAGELLAN ID
CA954224169OtherCIGNA BEH HEALTH ID
CA5422OZZZ22955ZOtherBLUE SHIELD ID
CA0004135139OtherAETNA ID
CA954224169OtherMHN/HMC ID
CA954224169OtherPACIFICARE ID