Provider Demographics
NPI:1710327440
Name:LUCINDA I CUERVO MD PA
Entity Type:Organization
Organization Name:LUCINDA I CUERVO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CUERVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD , PA
Authorized Official - Phone:305-274-5563
Mailing Address - Street 1:10661 N KENDALL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8709
Mailing Address - Country:US
Mailing Address - Phone:305-274-5563
Mailing Address - Fax:305-274-5565
Practice Address - Street 1:10661 N KENDALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8709
Practice Address - Country:US
Practice Address - Phone:305-274-5563
Practice Address - Fax:305-274-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96609Medicare PIN