Basic Information
| Provider Information | |||||||||
| NPI: | 1285681999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POZUELO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DEFATIMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | A90 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404424452 | ||||||||
| FaxNumber: | 4404420571 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | A90 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404424452 | ||||||||
| FaxNumber: | 4404420571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 35072078 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P00224699 | 01 | OH | RAILROAD CARE | OTHER | 000000369587 | 01 | OH | ANTHEM BC/BS | OTHER | 352693 | 01 | OH | WELLCARE | OTHER | 202394952027 | 01 | OH | CARESOURCE | OTHER | R72078 | 01 | OH | AUMMA/APEX | OTHER | 2330561 | 05 | OH | MEDICAID |