Healthcare Provider Details

I. General information

NPI: 1417529488
Provider Name (Legal Business Name): YESENIA CUERVO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 07/10/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 3RD AVE
CHULA VISTA CA
91911-3136
US

IV. Provider business mailing address

1132 SANTA DELPHINA AVE
CHULA VISTA CA
91913-1712
US

V. Phone/Fax

Practice location:
  • Phone: 619-597-1764
  • Fax:
Mailing address:
  • Phone: 619-565-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number718060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: