Active NPI
Lizdany Cuello Dominguez, SA-C
- Surgical Assistant
- Cleveland, OH
National Provider Identifier
1013547611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 19-454
- Practice address
- 12212 Larchmere Blvd
Cleveland, OH 44120-1102 - Phone
- (216) 507-3309
- NPI assigned
- Jan 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 19-454 | WI | Primary |
Addresses
Primary practice location
12212 Larchmere Blvd
Cleveland, OH 44120-1102
Mailing address
12212 Larchmere Blvd
Cleveland, OH 44120-1102
Phone (216) 507-3309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-454 | WI | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584316800000",
"number": "1013547611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12212 LARCHMERE BLVD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441201102",
"telephone_number": "216-507-3309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12212 LARCHMERE BLVD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441201102",
"telephone_number": "216-507-3309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUELLO DOMINGUEZ",
"first_name": "LIZDANY",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-03-16",
"certification_date": "2020-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "WI",
"license": "19-454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.