Healthcare Provider Details

I. General information

NPI: 1811940380
Provider Name (Legal Business Name): JOSE MARCELO LLERENA-RIQUELME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JOSE MARCELO LLERENA

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-5503
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-5503
US

V. Phone/Fax

Practice location:
  • Phone: 216-448-0621
  • Fax: 216-448-0220
Mailing address:
  • Phone: 216-448-0621
  • Fax: 216-448-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberK4488
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberK4488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: