Healthcare Provider Details

I. General information

NPI: 1497687578
Provider Name (Legal Business Name): JOSEPH MANUEL BOZADA IV CDCA PRELIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E 45TH ST STE 106
CLEVELAND OH
44127-1088
US

IV. Provider business mailing address

3100 E 45TH ST STE 106
CLEVELAND OH
44127-1088
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-7177
  • Fax:
Mailing address:
  • Phone: 216-798-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number196257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: