Provider Demographics
NPI:1124661327
Name:YUZON, MARIA TERESA
Entity type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:YUZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6064 KYRA LN
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1878
Mailing Address - Country:US
Mailing Address - Phone:440-989-2123
Mailing Address - Fax:
Practice Address - Street 1:6064 KYRA LN
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1878
Practice Address - Country:US
Practice Address - Phone:440-989-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH504100343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489055OtherUS DOT