Provider Demographics
NPI:1093839490
Name:WESTLAKE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WESTLAKE MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAFIN
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:440-871-3655
Mailing Address - Street 1:26314 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4028
Mailing Address - Country:US
Mailing Address - Phone:440-871-3655
Mailing Address - Fax:440-871-0740
Practice Address - Street 1:26314 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4028
Practice Address - Country:US
Practice Address - Phone:440-871-3655
Practice Address - Fax:440-871-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-034119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228668Medicaid
OHC00957Medicare UPIN
OHGA0372375Medicare ID - Type Unspecified