Provider Demographics
NPI:1134456023
Name:NERVO, DAVID I (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:NERVO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6895 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-9526
Mailing Address - Country:US
Mailing Address - Phone:530-365-6889
Mailing Address - Fax:
Practice Address - Street 1:6895 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-9526
Practice Address - Country:US
Practice Address - Phone:530-365-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2022-07-15
Deactivation Date:2009-12-22
Deactivation Code:
Reactivation Date:2022-07-06
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical