Healthcare Provider Details

I. General information

NPI: 1700975471
Provider Name (Legal Business Name): ISABELITA GUADIZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24700 LORAIN RD SUITE 104
NORTH OLMSTED OH
44070-2088
US

IV. Provider business mailing address

PO BOX 451339
WESTLAKE OH
44145-0635
US

V. Phone/Fax

Practice location:
  • Phone: 440-716-9810
  • Fax: 440-716-9813
Mailing address:
  • Phone: 440-808-3700
  • Fax: 440-808-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ISABELITA E GUADIZ
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 440-716-9810