Provider Demographics
NPI:1770207458
Name:CUERVO, MARIO ALEJANDRO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ALEJANDRO
Last Name:CUERVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NW 47TH AVE APT W201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2569
Mailing Address - Country:US
Mailing Address - Phone:786-857-4796
Mailing Address - Fax:786-724-1404
Practice Address - Street 1:801 NW 47TH AVE APT W201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2569
Practice Address - Country:US
Practice Address - Phone:786-857-4796
Practice Address - Fax:786-724-1404
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician