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General NPI Number Information
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NPI Number | 1578616371
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Entity Type | Organization
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Legal Business Name | HERMINIO CUERVO MD PA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1601 WILLIAMSBURG SQ
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City | LAKELAND
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State | FL
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Zip | 33803-4279
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Country | US
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Telephone | 863-647-1684
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Fax | 863-647-2824
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Provider Business Mailing Address
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Address Line | 1601 WILLIAMSBURG SQ
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City | LAKELAND
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State | FL
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Zip | 33803-4279
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Country | US
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Telephone | 863-647-1684
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Fax | 863-647-2824
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HERMINIO CUERVO
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Credential | M.D.
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Telephone | 863-647-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME0031030
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License Number State | FL
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