=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811431364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GHUNWA NAKOUZI PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2016
-----------------------------------------------------
Last Update Date | 01/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31000 WILDERNESS TRL
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-269-7703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31000 WILDERNESS TRL
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0202X
-----------------------------------------------------
Taxonomy Name | Clinical Biochemical Genetics Physician
-----------------------------------------------------
License Number | NAKOG1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207SG0203X
-----------------------------------------------------
Taxonomy Name | Clinical Molecular Genetics Physician
-----------------------------------------------------
License Number | NAKOG1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------