Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 230933 | MA |
Y | 207N00000X | Dermatologist | 35-084764 | OH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 35-084764 | OH |
N | 207NS0135X | Procedural Dermatology | 35-084764 | OH |
NPI | 1407979529 |
---|---|
Provider Name | Jorge A Garcia-Zuazaga |
First Address | Pepper Pike, OH 44124-4847 |
Second Address | Pepper Pike, OH 44124-4847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 16/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2806708 | (05) | OH |