1982700621 NPI number — FATIMA M POZUELO MD INC

Table of content: CHRISTOPHER DABNEY HEFFNER MD (NPI 1740286335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982700621 NPI number — FATIMA M POZUELO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FATIMA M POZUELO MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982700621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-808-3700
Provider Business Mailing Address Fax Number:
440-808-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 MAYFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 537
Provider Business Practice Location Address City Name:
MAYFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-442-4452
Provider Business Practice Location Address Fax Number:
440-442-0571
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POZUELO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
DEFATIMA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-442-4452

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  50000722 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DD3839 . This is a "RAILROAD CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".