Provider Demographics
NPI:1588873475
Name:CERVANTES, ROBERTO (DEPRESSION COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:DEPRESSION COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3476
Mailing Address - Country:US
Mailing Address - Phone:619-662-4124
Mailing Address - Fax:619-662-4198
Practice Address - Street 1:1275 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3476
Practice Address - Country:US
Practice Address - Phone:619-662-4124
Practice Address - Fax:619-662-4198
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health