Basic Information
| Provider Information | |||||||||
| NPI: | 1013914100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARAIZA | ||||||||
| FirstName: | BEATRIX | ||||||||
| MiddleName: | DAGMAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OUICKERT | ||||||||
| OtherFirstName: | BEATRIX | ||||||||
| OtherMiddleName: | DAGMAR | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3700 PARK EAST DR | ||||||||
| Address2: | SUIT 300 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552921401 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 PARK EAST DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552921401 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME75351 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 43401 | 01 | BCBS | OTHER | 7100091260 | 05 | KY | MEDICAID | 300138468 | 01 | RRNUM | OTHER | Q75351 | 05 | SC | MEDICAID | 1013914100 | 05 | CA | MEDICAID | 048775300 | 05 | DC | MEDICAID | 254634500 | 05 | FL | MEDICAID | 262433800 | 05 | FL | MEDICAID | 323208500 | 05 | MD | MEDICAID | 102338070 | 05 | PA | MEDICAID | 2761425 | 05 | OH | MEDICAID | 808324000 | 05 | ID | MEDICAID |