Healthcare Provider Details

I. General information

NPI: 1184988958
Provider Name (Legal Business Name): CLAUDIA CUERVO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

IV. Provider business mailing address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2630
  • Fax: 507-455-8133
Mailing address:
  • Phone: 507-451-2630
  • Fax: 507-455-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number303784
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70271
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: