Provider Demographics
NPI:1801562947
Name:ZAMUDIO, LOUIS JR (RN)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:ZAMUDIO
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2734
Mailing Address - Country:US
Mailing Address - Phone:330-559-3029
Mailing Address - Fax:
Practice Address - Street 1:24100 CHAGRIN BLVD STE 125
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5535
Practice Address - Country:US
Practice Address - Phone:216-714-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.406541163W00000X
OHAPRN.CNP.0032424363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse