Provider Demographics
NPI:1215031471
Name:LUIS & AMELIA LLERENA MDS INC
Entity Type:Organization
Organization Name:LUIS & AMELIA LLERENA MDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-835-6120
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-835-6120
Mailing Address - Fax:440-892-6631
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-835-6120
Practice Address - Fax:440-892-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH046514207R00000X
OH042061207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9918732Medicare ID - Type Unspecified
A78493Medicare UPIN
A80727Medicare UPIN
OH9918731Medicare ID - Type Unspecified
OH0548090Medicare ID - Type Unspecified