Healthcare Provider Details

I. General information

NPI: 1851445837
Provider Name (Legal Business Name): DIEGO RICARDO CUERVO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 HAYGOOD RD SUITE C
VIRGINIA BEACH VA
23455-5447
US

IV. Provider business mailing address

4652 HAYGOOD RD SUITE C
VIRGINIA BEACH VA
23455-5447
US

V. Phone/Fax

Practice location:
  • Phone: 757-363-0118
  • Fax: 757-363-8932
Mailing address:
  • Phone: 757-363-0118
  • Fax: 757-363-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001964
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: