Provider Demographics
NPI:1306502869
Name:CERVANTES, MELISSA V
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:V
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 1:125 W F ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3201
Mailing Address - Country:US
Mailing Address - Phone:909-563-7076
Mailing Address - Fax:909-986-4550
Practice Address - Street 1:125 W F ST STE 101
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3201
Practice Address - Country:US
Practice Address - Phone:909-563-7076
Practice Address - Fax:909-986-4550
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)