Healthcare Provider Details

I. General information

NPI: 1629298971
Provider Name (Legal Business Name): ACEN WARAIDZO OLOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GLESSNER AVE
MANSFIELD OH
44903-2269
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 419-520-2468
  • Fax: 419-520-2469
Mailing address:
  • Phone: 419-520-2468
  • Fax: 419-520-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.090546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: