Provider Demographics
NPI:1578664363
Name:CUERVO, MARIO S (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:S
Last Name:CUERVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SW 72 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-630-1400
Mailing Address - Fax:800-370-1116
Practice Address - Street 1:10200 SW 72 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3033
Practice Address - Country:US
Practice Address - Phone:305-630-1400
Practice Address - Fax:800-370-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00407302084P0800X
FLME00407302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067087100Medicaid
FL96033Medicare ID - Type Unspecified
D63703Medicare UPIN