Healthcare Provider Details

I. General information

NPI: 1073851465
Provider Name (Legal Business Name): JUAN A. CUERVO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HARRY HINES BLVD DEPT. OF ANESTHESIOLOGY
DALLAS TX
75235-7708
US

IV. Provider business mailing address

PO BOX 660599
DALLAS TX
75266-0599
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number729570
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: