=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700975471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISABELITA GUADIZ MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24700 LORAIN RD SUITE 104
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-2088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-716-9810
-----------------------------------------------------
Fax | 440-716-9813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 451339
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-0635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-808-3700
-----------------------------------------------------
Fax | 440-808-3675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / OWNER
-----------------------------------------------------
Name | DR. ISABELITA E GUADIZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-716-9810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------