Provider Demographics
NPI:1144365404
Name:CUERVO, DINA (PHD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:CUERVO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S ALMANSOR ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4231
Mailing Address - Country:US
Mailing Address - Phone:626-319-5995
Mailing Address - Fax:
Practice Address - Street 1:3250 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1449
Practice Address - Country:US
Practice Address - Phone:323-361-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24914103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent