Healthcare Provider Details

I. General information

NPI: 1578664363
Provider Name (Legal Business Name): MARIO S CUERVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 W FLAGLER ST
CORAL GABLES FL
33134-1604
US

IV. Provider business mailing address

2300 NW 89TH PL FL 3
DORAL FL
33172-2431
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-3400
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-398-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0040730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: