Provider Demographics
NPI:1225855778
Name:CERVANTES, YESENIA JEANETTE (RADT)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:JEANETTE
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6043
Mailing Address - Country:US
Mailing Address - Phone:559-667-6258
Mailing Address - Fax:
Practice Address - Street 1:1425 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1415
Practice Address - Country:US
Practice Address - Phone:559-625-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1581400924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)