Provider Demographics
NPI:1366411696
Name:GUADIZ, ISABELITA E (MD)
Entity type:Individual
Prefix:DR
First Name:ISABELITA
Middle Name:E
Last Name:GUADIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 LORAIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2088
Mailing Address - Country:US
Mailing Address - Phone:440-716-1283
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:24700 LORAIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2088
Practice Address - Country:US
Practice Address - Phone:440-716-1283
Practice Address - Fax:440-716-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341086808OtherTRICARE
OHF44904OtherSUMMACARE
OH4007324OtherAETNA
OH000000186288OtherANTHEM
OH0641943OtherBCMH
OH102430OtherKAISER
OH50881OtherQUALCHOICE
OH341086808026OtherCARESOURCE
OH0641943Medicaid
OHA80544Medicare UPIN