Healthcare Provider Details

I. General information

NPI: 1174582068
Provider Name (Legal Business Name): PATRICIA L PACZOS P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2402
  • Fax: 216-363-2145
Mailing address:
  • Phone: 216-363-2402
  • Fax: 216-363-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50 001067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: