Individual
MRS. CLARA GRACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2323 BROADVIEW RD, CLEVELAND, OH 44109-4177
(216) 661-5077
Mailing address
1508 AMBERLEY AVE, CLEVELAND, OH 44109-3504
(216) 789-3961
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
09201502
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15083961
15083961
OH
Enumeration date
04/19/2021
Last updated
04/19/2021
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