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General NPI Number Information
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NPI Number | 1144365404
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Entity Type | Individual
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Provider Name | DINA CUERVO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 3250 WILSHIRE BLVD STE 310
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City | LOS ANGELES
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State | CA
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Zip | 90010-1449
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Country | US
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Telephone | 323-361-7742
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Fax |
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Provider Business Mailing Address
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Address Line | 320 S ALMANSOR ST
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City | ALHAMBRA
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State | CA
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Zip | 91801-4231
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Country | US
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Telephone | 626-319-5995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY24914
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License Number State | CA
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