Provider Demographics
NPI:1528154218
Name:CERVANTES, NANCYANN N (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCYANN
Middle Name:N
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 1:30 NIGHTINGALE ROAD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524-0001
Mailing Address - Country:US
Mailing Address - Phone:661-277-5291
Mailing Address - Fax:661-277-6327
Practice Address - Street 1:30 NIGHTINGALE ROAD MENTAL HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-5641
Practice Address - Country:US
Practice Address - Phone:661-277-5291
Practice Address - Fax:661-277-6327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical