Healthcare Provider Details

I. General information

NPI: 1801635156
Provider Name (Legal Business Name): LIUBOV KOZUBIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23850 COMMERCE PARK STE C
BEACHWOOD OH
44122-5829
US

IV. Provider business mailing address

23850 COMMERCE PARK
BEACHWOOD OH
44122-5829
US

V. Phone/Fax

Practice location:
  • Phone: 440-219-0302
  • Fax: 440-439-6405
Mailing address:
  • Phone: 440-219-0302
  • Fax: 440-439-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: