Healthcare Provider Details

I. General information

NPI: 1982700621
Provider Name (Legal Business Name): FATIMA M POZUELO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD RD SUITE 537
MAYFIELD HEIGHTS OH
44124-2270
US

IV. Provider business mailing address

PO BOX 45465
WESTLAKE OH
44145-0465
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-4452
  • Fax: 440-442-0571
Mailing address:
  • Phone: 440-808-3700
  • Fax: 440-808-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50000722
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA DEFATIMA POZUELO
Title or Position: OWNER
Credential: MD
Phone: 440-442-4452