Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 35058175 | OH |
NPI | 1245297928 |
---|---|
Provider Name | Dr. Renato De Paz Querubin |
First Address | Lorain, OH 44053-1652 |
Second Address | Lorain, OH 44053-3173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 21/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0966361 | (05) | OH |
E85494 | (02) |