Provider Demographics
NPI:1730367780
Name:CERVANTES, OLGA (PSYD)
Entity type:Individual
Prefix:MS
First Name:OLGA
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26400 LA ALAMEDA
Mailing Address - Street 2:STE 208
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6307
Mailing Address - Country:US
Mailing Address - Phone:949-606-4698
Mailing Address - Fax:949-215-2529
Practice Address - Street 1:26400 LA ALAMEDA
Practice Address - Street 2:STE 208
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6307
Practice Address - Country:US
Practice Address - Phone:949-606-4698
Practice Address - Fax:949-215-2529
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA26900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist