Healthcare Provider Details

I. General information

NPI: 1871070201
Provider Name (Legal Business Name): BERNICE CUERVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 THIRD AVE
CHULA VISTA CA
91911-3136
US

IV. Provider business mailing address

3340 KEMPER ST STE 103
SAN DIEGO CA
92110-4907
US

V. Phone/Fax

Practice location:
  • Phone: 619-565-8880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1332221218
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: