Healthcare Provider Details

I. General information

NPI: 1801562947
Provider Name (Legal Business Name): LOUIS ZAMUDIO JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 CHAGRIN BLVD STE 125
BEACHWOOD OH
44122-5535
US

IV. Provider business mailing address

8507 TAHOE DR
MACEDONIA OH
44056-2734
US

V. Phone/Fax

Practice location:
  • Phone: 216-714-3278
  • Fax:
Mailing address:
  • Phone: 330-559-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0032424
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.406541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: