Provider Demographics
NPI:1376569855
Name:AMUNATEGUI, LUIS F (PHD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:AMUNATEGUI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-383-6616
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5482103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000533011OtherANTHEM
OH680015572OtherRAILROAD MEDICARE
OH000000224239OtherUNISON
OH363310OtherWELLCARE MEDICAID
OH2333291Medicaid
OH7613633OtherAETNA
OH000000533011OtherANTHEM
OHAMCP28122Medicare PIN
OH363310OtherWELLCARE MEDICAID
OH000000224239OtherUNISON