Provider Demographics
NPI:1245297928
Name:QUERUBIN, RENATO DE PAZ (MD)
Entity type:Individual
Prefix:DR
First Name:RENATO
Middle Name:DE PAZ
Last Name:QUERUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 222
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-282-7600
Mailing Address - Fax:440-282-7711
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 222
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3173
Practice Address - Country:US
Practice Address - Phone:440-282-7600
Practice Address - Fax:440-282-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058175207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0966361Medicaid
E85494Medicare UPIN
QU0835432Medicare ID - Type Unspecified