Healthcare Provider Details

I. General information

NPI: 1962843706
Provider Name (Legal Business Name): LYDA CUERVO PARDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # 100277
GAINESVILLE FL
32610
US

IV. Provider business mailing address

1600 SW ARCHER RD # 100277
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberACK
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME135311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: