Provider Information for 1619395910
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ERICA INNOCENT
Sex: Female
NPI: 1619395910
Last Updated: 2014-04-03
Certification Date:
Certification Date:
Details
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NPI | 1619395910 | ||||||||
Enumeration Date | 2014-04-03 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 3737 LANDER RD CLEVELAND, OH 44124-5712 United States Phone: | Fax: | ||||||||
Primary Practice Address | 11801 BUCKEYE CLEVELAND, OH 44120 United States Phone: 216-831-2255 | Fax: | ||||||||
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