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General NPI Number Information
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NPI Number | 1629524640
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Entity Type | Individual
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Provider Name | MARIA INMACULADA CUERVO Y BENNETT ATC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 1 CAMINO SANTA MARIA ST ATHLETIC TRAINING DEPARTMENT
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City | SAN ANTONIO
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State | TX
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Zip | 78228-5433
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Country | US
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Telephone | 210-431-5043
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 ROLLING OAK DR
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City | LAKELAND
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State | FL
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Zip | 33810-1286
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Country | US
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Telephone | 863-255-9953
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4686
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License Number State | FL
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