Healthcare Provider Details

I. General information

NPI: 1023582087
Provider Name (Legal Business Name): DINA YVONNE OZOLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 01/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121-2224 WALKER RD
WINDSOR ONTARIO
N8W 5L7
CA

IV. Provider business mailing address

899 KENWOOD BLVD
WINDSOR ON
N9J 3C5
CA

V. Phone/Fax

Practice location:
  • Phone: 519-252-4994
  • Fax: 519-252-4995
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301064465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: